Supervisor – Audit/Investigation

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

📋 Description

• Manage audits and investigations as well as the overall audit/investigation workload.

• Conduct thorough assessments and make field-level determinations regarding potential Medicare fraud, waste, and abuse cases.

• Evaluate incoming audits, investigations, and leads to assess their appropriateness and assign cases to auditors and investigators.

• Collaborate with relevant agencies and law enforcement to vet providers and oversee the vetting process.

• Analyze audit and investigation plans, priorities, files, requests, reports, and correspondence to ensure quality and appropriateness.

• Supervise and execute interviews, onsite audits, investigations, and site verifications.

• Lead audit and investigation projects, devise strategies, organize stakeholder meetings, assess project actions, and document findings.

• Liaise with Data and Medical Review departments.

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

• Record case information and file reviews in case tracking systems.

• Review findings and sanction courses of action and closing summaries.

• Prepare the team’s audits and investigations for Major Case Coordination meetings and conduct quality assurance reviews.

• Maintain communication with law enforcement and regulatory bodies, presenting findings for further action.

• Supervise administrative remedies such as payment suspensions, revocations, and provider education initiatives.

• Gather and submit information requested by both internal and external stakeholders, including CMS and law enforcement agencies.

• Work collaboratively with other program integrity contractors.

• Provide testimony in legal or administrative proceedings as required.

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

⛳️ Requirements

• A minimum of a Bachelor's Degree is required.

• 5 to 7 years of relevant experience is required; 8 to 11 years is preferred.

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

• Experience in overseeing Medicare and/or Medicaid fraud, waste, and abuse audits and investigations.

• Capability to conduct interviews, onsite audits, investigations, and site verifications as needed.

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

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

🏝️ Benefits

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

• Drug-free workplace environment.

• Job offers contingent upon successful completion of pre-employment background checks and drug screenings.