Site Inspector - Remote Wisconsin

Summary

The Site Inspector is responsible for conducting provider site visits and program integrity reviews in support of Wisconsin Medicaid provider enrollment and revalidation requirements. This role works closely with the Wisconsin Department of Health Services (DHS) Office of Inspector General (OIG) to verify provider operational readiness, validate compliance with CMS requirements, and support efforts to prevent fraud, waste, and abuse within the Medicaid program. Responsibilities include scheduling and conducting site inspections, documenting findings, performing research, and preparing legally defensible documentation related to enrollment actions and compliance reviews.

Your role in our mission

• Conduct onsite provider inspections to verify operational status, physical location, business signage, and the provider's ability to perform services identified within enrollment applications.
• Coordinate and schedule site visits with providers, including communication, appointment management, and utilization of virtual meeting technology when appropriate.
• Capture photographs, complete inspection templates, document findings, and upload supporting documentation into designated systems in accordance with established procedures.
• Perform enrollment program integrity compliance reviews, including research, analysis, and evaluation of provider information to identify potential compliance concerns.
• Prepare detailed reports, recommendations, and supporting documentation for enrollment determinations, sanctions, terminations, denials, and administrative review processes.

What we're looking for

• Two or more years of experience in inspections, auditing, investigations, compliance, healthcare operations, provider relations, program integrity, fraud prevention, or a related field.
• Experience conducting research, reviewing documentation, gathering information, and preparing detailed written reports while maintaining accuracy and confidentiality.
• Strong analytical, organizational, problem-solving, and communication skills with the ability to work independently and manage multiple priorities.
• Experience working with Medicaid, Medicare, healthcare providers, provider enrollment, regulatory compliance, program integrity, or government-sponsored healthcare programs preferred.
• Proficiency with Microsoft Office applications, documentation systems, databases, virtual meeting platforms, and technology used to support field-based work.

What you should expect in this role

• Field-based position requiring frequent travel throughout Wisconsin to conduct provider site visits and inspections.
• Direct interaction with healthcare providers, clinics, agencies, suppliers, and other Medicaid-enrolled organizations.
• Collaboration with Wisconsin DHS Office of Inspector General (OIG) and Gainwell program integrity and provider enrollment teams.
• Independent work environment requiring strong time management, scheduling, documentation, and case management skills.
• Opportunity to make a direct impact on Medicaid program integrity while supporting compliance initiatives that help prevent fraud, waste, and abuse within the healthcare system.

Pipeline Notice: This is a pipeline requisition. Gainwell will be screening and interviewing qualified candidates on an ongoing basis in anticipation of future hiring needs through the month of August.

Candidates who meet the qualifications may be contacted by a member of our Talent Acquisition team to discuss current and future opportunities.

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