NEOGOV · 1 day ago
Program Integrity Audit and Investigation Analyst 2026-00383
Cheyenne, WY
Full-time
Onsite
New Grad, Entry, Mid Level
$5,636.27/mo - $5,636.27/mo
0+ years expNEOGOV is seeking a Program Integrity Audit and Investigation Analyst to support the State of Wyoming's Department of Health. The role involves conducting audits and investigations to minimize fraud, waste, and abuse in the Medicaid system, collaborating with law enforcement, and ensuring compliance with regulations.
GovernmentSoftwareHuman ResourcesInformation TechnologyGovTech
No H1B
Responsibilities
Plan and conduct independent audits and investigations of Wyoming Medicaid State Plan and Waiver providers utilizing appropriate data analysis resources and tools
Review complex audit and investigation documentation, perform audit and investigation duties, and make remediation and corrective action plans based on audit or investigation findings
Make independent recommendations for the initiation of overpayment recovery actions based on audit or investigative findings
Collaborate with law enforcement and Attorney General staff to testify on findings at contested case hearings and civil or criminal legal proceedings
Make recommendations and identify areas requiring further investigation to the Audits and Investigations Supervisor
Coordinate efforts and act as the primary point of contact for the Unified Program Integrity Contractor
Coordinate referrals to the Unified Program Integrity Contractor (UPIC) and act as the primary point of contact for the federal UPIC, attending meetings, reporting on the ongoing status of referrals made, and coordinating the fulfillment of documentation requests
Update case file documentation to the PI case management system
Monitor ongoing status and outcome after referral
Oversee the monitoring of provider post-audit compliance, as outlined in the audit findings and corrective action plan
Set protocols and oversee implementation of provider self-audits and self-reporting
Draft procedure and policy related to the education of providers, notification of requirements, timelines, and findings
Facilitate and monitor the development, implementation, and execution of provider quality improvement plans
Direct validation of findings and written reports
Communicate recommendations to programs and management
Qualification
Required
Bachelor's Degree (typically in Records or Data Management)
0-3 years of progressive work experience in (typically in Records and Data Management) with acquired knowledge at the level of a Records & Data Management Specialist II
4-6 years of progressive work experience in (typically in Records and Data Management) with acquired knowledge at the level of a Records & Data Management Specialist II (if education and experience substitution is applicable)
Knowledge of healthcare delivery and regulatory systems, at both the State and Federal levels, and integrated automated systems currently used by the Division of Healthcare Financing
Knowledge of medical terminology, medical diagnostic and procedural terms, and common medical payment procedural codes used in Current Procedural Terminology (CPT) and other nationally recognized coding references
Knowledge of court proceedings, testimony, and administrative appeals
Knowledge of state and federal government functions, state and federal statutes, rules, regulations, policies, and procedures governing Federal and State Medicaid and Medicare programs
Knowledge of Medicaid law and regulatory structure, including State and Federal Medicaid statutes, regulations, and policies as outlined in the Code of Federal Regulations
Knowledge of fraud and abuse detection methods, internal control systems
Skills in research and analysis of complex problems; identification of options and solutions; decision making and evaluation of results
Skills in public speaking, oral and written communication to varied audiences on complex and controversial issues
Ability to establish and maintain positive working relationships with individuals and groups
Ability to accept and be flexible with federal, state, and agency changes
Ability to balance multiple demands on time and resources
Ability to self-educate both formally and informally to remain current in areas of responsibility
Skill in operating computer equipment and software programs, including Microsoft Excel, PowerPoint, SharePoint, Word, COGNOS Business Intelligence Tools, BMS and case management systems
Skill in active listening, creative problem-solving skills; strong oral, written, and interpersonal communication skills at a variety of levels and with multiple audiences
Skill in critical thinking, with an ability to evaluate complex sets of data and information to determine whether aberrancies, patterns, or discrepancies exist
Skill in establishing and maintaining effective working relationships with other program managers, providers, and the public
Ability to work independently with minimal supervision while balancing multiple demands on time and resources
Ability to utilize sound judgment in decision making, and formulate concise answers and plans with known information while interpreting DHCF rules, policies, and procedures
Ability to analyze and comprehend complex Medicaid service utilization, provider enrollment, and client eligibility data; identify patterns, trends, problems, and solutions; leverage deductive reasoning skills to form sound conclusions
Ability to draft concise reports utilizing technical writing tools and techniques
Experience demonstrating the ability to collect and organize information from complex data systems
Experience in decision making and evaluation of results to make future program recommendations based on trends; Experience gathering and compiling data to meet Program Integrity user needs through the use of tables, charts, graphs, and written reports
Must be detail-oriented, highly organized, and self-motivated
Must maintain a high level of confidentiality both inside and outside of DHCF
Preferred
Bachelor's degree in a related field—such as Human Services, Accounting, Statistics, or Criminal Justice—and 1–3 years of progressive experience in auditing, investigations, data analytics, or compliance analysis
Individuals with a degree and background that demonstrate the analytical and investigative skills necessary to perform quality assurance and investigative techniques
Benefits
Comprehensive health, dental, and vision insurance
Paid vacation, sick leave, FMLA, and holidays
Retirement - Pension and 457B plans that help you build a secure future
Flexible schedules and work-life balance options
Meaningful work that makes a difference for Wyoming communities
Voluntary Benefits – including life insurance for you and family members, ambulance, pet insurance, short/long-term disability, flex spending and health savings accounts
Multiple retirement options – including the Wyoming Retirement System and a 457B account, helping you plan for long-term financial security
Generous paid leave and flexible schedules – vacation, sick leave, paid FMLA and 11 paid holidays each year
Public Service Loan Forgiveness eligibility – for those with qualifying student loans
Training and professional development – to support your career growth and advancement
Employee Assistance Program– Includes paid short-term counseling, legal, financial and work-life benefits and select employee discounts
Wellness Program– Earn paid time off and incentives by focusing on your personal health
Company
NEOGOV
NEOGOV is the leading provider of workforce management software uniquely designed for the public sector, education, and public safety.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$700MKey Investors
The Carlyle Group,Warburg PincusWarburg Pincus
2025-07-28Secondary Market· $700M
2025-07-28Acquired
2021-06-02Private Equity
Leadership Team
Shane Evangelist
CEO
Brandon McDonald
Head Of Marketing
Recent News
Canada NewsWire
2025-11-14
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2025-10-31
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