Program Integrity Ideation Analyst Jobs (NOW HIRING)

Seeking a detail-oriented and proactive Program and Compliance Analyst to support oversight and compliance for Medicaid School-Based Services (SBS) program and Medicaid benefits authorized under an Individual Family Service Plan (IFSP). This position is responsible for ensuring that Local Education Agencies (LEAs) and related Medicaid providers compliance with Medicaid regulations and newly issued federal CMS guidance, including requirements around documentation, service delivery, and claiming.
The analyst will manage time study methodologies (e.g., Random Moment Time Study – RMTS), develop policy guidance, and help build robust oversight infrastructure. A strong focus will be placed on program integrity, with responsibility for identifying and mitigating risks related to fraud, waste, and abuse (FWA).
This role requires a balance of independent research and analysis with cross-agency collaboration and technical assistance.

• Monitor and ensure LEA compliance with Medicaid SBS billing and documentation standards, including program integrity requirements and CMS policy updates.
• Oversee the administration and quality assurance of time study methodologies such as RMTS, including moment validation, staff training, and participation tracking.
• Develop, update, and disseminate program policy guidance, compliance toolkits, training materials, and FAQs for LEAs, administrative vendors, and internal staff.
• Build and maintain a compliance monitoring system, including tools for site visits, desk audits, and corrective action tracking.
• Conduct risk assessments and monitor claims data to proactively identify potential FWA, inappropriate billing patterns, and non-compliant provider behavior.
• Support the Medicaid Program Integrity and Compliance Unit in conducting reviews, investigations, and audit responses related to school-based services and related Medicaid benefits authorized under an IFSP.
• Collaborate with legal, finance, and program staff to align SBS operations and related Medicaid benefits authorized under an IFSP with broader Medicaid compliance and FWA prevention strategies.
• Provide technical assistance and serve as a subject matter expert for LEAs navigating Medicaid billing requirements.
• Support development of State Plan Amendments (SPAs) or other federal submissions as needed to align program operations with policy changes.
• Coordinate with the school districts to align Medicaid SBS policy with educational frameworks and service delivery models.
• Oversee and validate provider enrollment and qualifications to ensure compliance with State and federal Medicaid requirements for school-based service providers.
• Collaborate with the SBS grant project manager to assist in revising policy and guidance documentation, ensuring alignment with planned state policy changes and future program developments.

• Bachelor’s degree in public health, public policy, education, health care administration, or a related field (master's degree preferred).
• Minimum 3–5 years of experience in Medicaid program compliance, school-based services, or program operations with a regulatory component.
• Knowledge of Medicaid billing practices, especially for school-based or community-based services and understanding of time studies like RMTS.
• Experience with program integrity principles, including preventing and detecting fraud, waste, and abuse in public programs.
• Demonstrated ability to conduct independent policy research, analyze regulatory changes, and translate them into actionable guidance.
• Strong interpersonal skills with ability to communicate effectively with technical and non-technical audiences across agencies.

• Experience with Medicaid administrative claiming, cost allocation, or CMS program audits.
• Familiarity with Free Care policy, IEP/504-related billing, and school-based health services.
• Experience designing compliance monitoring tools or dashboards to track outcomes and risks.
• Familiarity with local school districts and policies.