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

📋 Description

• Perform audits and evaluations of various Medicaid programs to ensure compliance with federal and state Medicaid regulations and to recover overpayments.

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

• Execute compliance audits on diverse Medicaid case types, review claim submissions, and carry out targeted audits as needed.

• Manage multiple tasks simultaneously; organize and analyze billing trends; conduct interviews and gather statements from beneficiaries/recipients and other relevant parties.

• Identify findings, compliance issues, conflicts of interest, and improper payments; offer recommendations for enhancements.

• Organize case files and meticulously document all actions taken.

• Work autonomously or collaboratively within a team and provide progress reports and updates on audit status.

• Present verified data concerns, cite regulatory violations, and document fraudulent schemes or scams against the Government.

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

• Ensure timely, comprehensive, and precise project completion.

• Actively participate in meetings and engage in training sessions.

⛳️ Requirements

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

• Background in accounting or a related business area, law enforcement, health science, or a comparable field.

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

• Knowledge of Medicare/Medicaid or healthcare auditing practices.

• Excellent research and analytical capabilities.

• Proficient in Microsoft Office applications, with intermediate to advanced skills in Excel.

• Must be a US Citizen.

• Candidates should 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.