Supervisor – Audit, Investigation

This is a fully remote position, open to applicants in Colorado, +5 more states.

📋 Description

• Manage the audit and investigation processes along with the associated workload.

• Assess potential cases of Medicare and/or Medicaid fraud, waste, and abuse or compliance issues, and make suitable referrals.

• Analyze incoming leads, allocate tasks to auditors or investigators, and oversee the vetting of providers.

• Examine audit/investigation plans, priorities, documents, information requests, reports, and correspondence for accuracy and relevance.

• Supervise and conduct interviews, onsite audits/investigations, and site verifications as necessary.

• Direct audit/investigation projects, formulate strategies, hold stakeholder meetings, review project actions, and document conclusions.

• Collaborate with the Data and Medical Review departments.

• Prepare and present audits/investigations, overpayments, and inquiries for stakeholder meetings.

• Record case details and review files in case tracking systems.

• Analyze findings and authorize actions, including closing summaries and administrative remedies.

• Organize the team's audits/investigations for Major Case Coordination meetings and conduct quality assurance reviews.

• Liaise with law enforcement and regulatory bodies regarding ongoing investigations, prosecutions, or regulatory/administrative actions.

• Gather and submit information requested by CMS, law enforcement, and other stakeholders, including FOIA inquiries.

• Work in partnership with other program integrity contractors.

• Provide testimony at legal or administrative hearings as required.

• Oversee team performance through feedback and formal performance evaluations to enhance service delivery, engagement, motivation, and professional growth.

⛳️ Requirements

• A minimum of a Bachelor's Degree is required; education may be substituted for relevant experience.

• 5–7 years of related experience is required; 8–11 years is preferred; work experience may substitute for educational qualifications.

• Certification as a Fraud Examiner or Accredited Healthcare Anti-fraud Investigator is preferred.

• Capability to manage Medicare and/or Medicaid fraud, waste, and abuse audits/investigations.

• Proficiency in supervising auditors/investigators and reviewing audit/investigation plans, files, findings, and reports.

• Strong communication skills to engage with law enforcement, regulatory agencies, stakeholders, and contractors.

• Ability to provide testimony at legal or administrative proceedings when necessary.

• Successful completion of pre-employment background checks and drug screenings is required.

🏝️ Benefits

• Equal Opportunity Employer for Minorities, Females, Protected Veterans, and Individuals with Disabilities.

• A drug-free workplace.

• Offers contingent upon the successful completion of pre-employment background checks and drug screenings.