Medicaid Fraud Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

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

• Recover overpayments resulting from non-compliance.

• Research and interpret applicable laws and regulations.

• Conduct data analysis and draw conclusions related to projects.

• Execute compliance audits across a variety of Medicaid case types, audit claim submissions, and carry out ad hoc focused audits.

• Organize and analyze billing patterns effectively.

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

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

• Organize case files and meticulously document all actions taken.

• Work independently or collaboratively within a team, providing progress reports and updates on audit status.

• Present issues of concern, substantiated by data, and cite regulatory violations.

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

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

• Participate in meetings and attend relevant training sessions.

⛳️ Requirements

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

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

• Knowledge of internal audit and investigative policies and operating principles.

• Understanding of Medicare, Medicaid, or healthcare auditing processes.

• Strong research and analytical abilities.

• Proficiency in Microsoft Office tools, particularly intermediate to advanced skills in Excel.

• Must be a U.S. Citizen.

• Intermediate financial and business acumen is preferred.

• Preferred intermediate audit and investigative skills.

• Project management skills are preferred.

• Familiarity with the healthcare industry and medical coding concepts, along with experience analyzing healthcare claims data, is preferred.

🏝️ Benefits

• Telework options available from any state in the U.S.

• Employees may qualify for overtime pay.

• Employees may be eligible for shift differentials.

• Employees may receive discretionary bonuses.

• Commitment to equal opportunity employment, including for individuals with disabilities and protected veterans.