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

📋 Description

• Perform audits and evaluations of Medicaid programs to ensure adherence to federal and state regulations.

• Recover overpayments caused by non-compliance.

• Research and interpret applicable laws and regulations.

• Conduct data analysis and derive conclusions.

• Execute compliance audits, claims submission audits, and targeted audits.

• Organize and analyze billing trends.

• Conduct interviews and gather statements from beneficiaries, recipients, and other relevant parties.

• Identify findings, compliance exceptions, potential conflicts of interest, and improper payments.

• Organize case files and document all actions taken.

• Provide progress reports and updates on audit statuses.

• Present data-verified concerns and regulatory violations, including instances of fraud.

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

• Work independently or collaboratively within a team under general supervision.

• Ensure that projects are completed accurately and on time.

• Participate in meetings and attend training sessions.

⛳️ Requirements

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

• Relevant experience in accounting, a closely related business field, law enforcement, health science, or a similar area.

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

• Understanding of Medicare/Medicaid or healthcare auditing practices.

• Strong research and analytical capabilities.

• Proficiency in Microsoft Office tools, particularly Excel, at an intermediate to advanced level.

• Must be a US Citizen.

• Candidates must reside within the Northeast Jurisdiction: Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, District of Columbia, or Virginia.

🏝️ Benefits

• Employees may qualify for overtime pay.

• Shift differentials may be offered.

• Discretionary bonuses may be available.