Medicaid Auditor – Investigator

This is a fully remote position, open to applicants in Connecticut, +10 more states.

📋 Description

• Perform audits and assessments of various Medicaid programs to ensure adherence to federal and state Medicaid requirements and recover over-payments due to non-compliance.

• Investigate, interpret laws and regulations, conduct data analysis, and formulate conclusions for various projects.

• Execute compliance audits on different Medicaid case types, review claim submissions, and carry out focused ad-hoc audits.

• Manage multiple assignments simultaneously; organize and analyze billing patterns; conduct interviews and gather statements from beneficiaries, recipients, and other relevant parties.

• Gain a comprehensive understanding of the audited functions, applying business knowledge, analytical capabilities, and experience to identify findings and propose recommendations for enhancements.

• Detect compliance violations, conflicts of interest, and improper payments.

• Systematically organize case files and meticulously document all actions taken.

• Work autonomously or collaboratively within a team, providing regular progress reports and updates regarding audit status.

• Highlight verified issues of concern using data, citing regulatory breaches and demonstrating schemes or fraud attempts against the Government.

• Draft correspondence, reports, and summary letters for referrals.

• Operate under general supervision as part of a team committed to delivering superior quality work.

• Ensure that projects are completed on time, are thorough, and maintain accuracy.

• Engage actively in meetings and participate in training to enhance business acumen.

⛳️ Requirements

• 2 years of experience with a BS/BA degree or 6 years with a high school diploma.

• Background in accounting or a closely related field, law enforcement, health sciences, or a related domain.

• Familiarity with internal audit/investigative policies and operational principles.

• Understanding of Medicare/Medicaid systems or healthcare auditing practices.

• Strong research and analytical abilities.

• Proficient in Microsoft Office tools, with intermediate to advanced knowledge of Excel.

• Must be a U.S. Citizen.

• Intermediate level of financial and business understanding.

• Intermediate audit/investigative expertise.

• Skills in project management.

• Preferred knowledge of the healthcare sector and medical coding concepts, along with experience in analyzing healthcare claims data.

🏝️ Benefits

• Comprehensive health and wellness benefits.

• Opportunities for professional development and career advancement.

• Flexible work arrangements to promote work-life balance.

• Competitive salary and performance-based incentives.