Medicaid Fraud Auditor

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 resulting from non-compliance issues.

• Investigate and interpret relevant laws and regulations.

• Conduct data analysis and derive conclusions.

• Execute compliance audits on various Medicaid case types and review claim submissions.

• Carry out targeted ad-hoc audits.

• Organize and evaluate billing trends.

• Interview beneficiaries, recipients, and other relevant parties to obtain statements.

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

• Arrange case files and meticulously document all actions taken.

• Provide progress reports and updates on audit status.

• Present concerns backed by data, along with regulatory violations and fraud schemes.

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

• Attend meetings and training sessions.

• Ensure that projects are completed in a timely, thorough, and precise manner.

⛳️ 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 business area, law enforcement, health science, or similar field.

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

• Knowledge of Medicare/Medicaid or healthcare auditing practices.

• Strong skills in research and analysis.

• Intermediate to advanced proficiency in Microsoft Office applications, particularly Excel.

• Must be a US Citizen.

• Intermediate financial and business understanding.

• Intermediate skills in auditing and investigations.

• Project management capabilities.

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

🏝️ Benefits

• Employees may qualify for overtime compensation.

• Shift differentials may be available.

• A discretionary bonus may also be offered.