Program Integrity Investigator Jobs in Michigan (NOW HIRING)

Functional Role (not inclusive of titles or advancement career progression)

Assist the Integrity and Compliance Director with guiding and managing the complianceactivities andinitiativesfor assigned ministry(ies).Provides advice,guidanceand program management to ministry leaders in developing,implementingandattainingprogram goalswhile ensuringalignment tocompliance strategies.Conducts investigations for local ministryand provides recommended action in response to outcome of investigation.Participatesin Service Area and Enterprise Integrity and Compliance projects with a focus on standardization and process improvements.

• Support the Integrity and Compliance Director in developing, executing, and overseeing compliance initiatives within the ministry.

• Provide expert advice and strategic guidance to ministry leaders on program goals and compliance strategies.

• Lead and conduct internal investigations related to compliance concerns, ensuring thorough,timely, and objective outcomes.

• Deliver well-documented recommendations for corrective actions based on investigative findings.

• Partner with leaders across local ministries and enterprise functions to implement and sustain compliance strategies.

• Activelyparticipatein Service Area and Enterprise-level compliance projects, focusing on process improvement and standardization.

• Collaborate on the development and rollout of organization-wide policies, training, and communication tools to foster a culture of ethics and compliance.

• Monitor emerging risk areas and regulatory changes, ensuring proactive andappropriate organizationalresponse.

• Contribute to audit readiness activities and help strengthen internal controls across the ministry.

• Track compliance performance metrics and support continuous improvement initiatives to enhance overall program effectiveness.

Minimum Qualifications

Bachelor'slevel degree in business,health administration,or arelated field, a law degree, or an equivalent combination of education & experience.

Minimum of five 5 years of relevant experience with increasing levels of responsibility in health care compliance &/or consulting including regulatory compliance, program metrics, performance assessment, & reporting outcomes, etc.

Mustpossessa thorough understanding and knowledge of health care legal and regulatory practices, financial and internal control systems/procedures.

Previousproject, program,supervisoryor management experience.

Additional Qualifications (nice to have)

Experience within a health care organization (including ambulatory and hospital settings) or equivalent workexperienceinvolving clinical documentation and coding reviewsand working knowledge ofConditions of Payment includinggovernmentandthird- party payer regulations.Mustunderstand and haveexpertisewith Patient Driven Payment Models, Patient Driven Groupings Models, IRF-PAI and OASIS requirements.Comprehensive understanding of Medicare Physician Fee Schedule and Medicare Claims Processing Manual for professional services..Comprehensive understanding of Conditions of Participation and Accreditation Standards.

CHC, CHPC, CHRC, CCEP or equivalent certification.

Lean/Six Sigma training and/or certification

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Physical & Mental Requirements & WorkingConditions (General Summary)

Direct Healthcare Services / Indirect Healthcare / Support Services:

• Exposure to conditions which may be considered unpleasant to sight, touch, sound& /or smell.Occasional

• Exposure to fumes, odors,dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.).Occasional

• Exposure to or subject to noise, infectious waste, diseases & conditions.Occasional

• Exposure to interruptions, shiftingpriorities& stressfulsituations.Frequent

• Ability to follow tasksthrough tocompletion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens overlong periodsof time & work on concurrent tasks / projects.Frequent

• Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person& /or over the phone / computer / device / equipment assigned) with some background noise.Frequent

• Perform manual dexterity activities & / or grasping / handling.Continuous

• Ability to climb, kneel,crouch & /oroperatefoot controls.Occasional

• Use a computer / other technology.Frequent

• Sit with the ability to vary / adjust physical position or activity.Frequent

• Maintain a safe working environment & use available personal protective equipment (PPE).Continuous

• Comply withTrinity Health's Code of Conduct, policies, procedures & guidelines.Continuous

• Ability toprovide assistancein the event of an emergency.Occasional

Direct Healthcare Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity.Occasional

• Lift a maximum of 30 pounds unassisted. Occasional

• Use upper & lower extremities, engage in bending / stooping /reaching& pushing / pulling. Occasional

• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions.Continuous

• Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions.Occasional

• Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients).Occasional

Indirect Healthcare / Support Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity.Occasional

• Lift a maximum of 30 pounds unassisted.Occasional

• Experience oflong periodsof walking / standing / stooping / bending / pulling & / or pushing.Occasional

• Encounter a clinical / patient facing / hands on interactive work environment.Occasional

• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions.Continuous

• Work outdoors with variable external environmental conditions.Occasional

• Hourly pay ranges: $47.23 - $70.85

Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)