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Auditor, Medicaid (Full-time, Remote)

Posted 2024-10-01

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💎 Seniority level: Middle, Typically 2+ years of related experience

🔍 Industry: Healthcare

⏳ Experience: Typically 2+ years of related experience

Requirements:
  • Bachelor's degree is required.
  • Typically 2+ years of related experience in finance, accounting, or auditing.
  • Experience in Medicaid managed care and an understanding of internal audit policies.
  • Strong writing skills to develop clear and comprehensive reports.
  • Certifications such as CPA, CFE, and/or AHFI are a plus.
  • Experience with Unified Case Management (UCM) and data analysis tools.
  • Knowledge of healthcare coding concepts (CPT, ICD-9/10, DRGs) is beneficial.
Responsibilities:
  • Perform audits on Medicaid service providers focusing on records, accounts, medical billing, and fiscal procedures.
  • Verify appropriateness of service provider charges for Medicaid eligible clients.
  • Prepare written reports summarizing audit conclusions and maintain audit notes.
  • Track and document audit activities in databases and prepare analytical exhibits.
  • Conduct research on applicable State regulations and ensure compliance.
  • Participate in on-site audits and gather necessary medical records.
  • Ensure adherence to GAGAS standards and participate in field investigations.
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Related Jobs

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🔥 Auditor, Medicaid (Full-time, Remote)
Posted 2024-10-15

📍 United States

🧭 Full-Time

🔍 Healthcare compliance and fraud prevention

🏢 Company: Integrity Management Services, Inc.

  • Bachelor’s degree is required.
  • Typically 2+ years of related experience in finance, accounting, or auditing.
  • Medicaid managed care work experience.
  • Intermediate understanding of Medicaid managed care.
  • Intermediate knowledge of internal audit policies and operating principles.
  • Sufficient writing skills to write a report that clearly identifies any fraud discovered, is easily comprehended, is complete, is thorough, and is accurate and supported by sufficient documentation.
  • CPA, CFE, and/or AHFI certification is a plus.
  • Used Unified Case Management (UCM) and One PI Business Objects.
  • Managed large/varied caseloads.
  • Reviewed medical claims and developing fraud cases.
  • Applied company policies and procedures in relation to complex investigations.
  • Reviewed financial records and advise or assist in the investigation of alleged fraud.
  • Experience with statistical sampling and/or advanced statistical training.
  • Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data.

  • The Medicaid Auditor will perform audits as assigned, which consist of but are not limited to: Examination of all records, accounts, controls, medical billing and fiscal procedures of a Medicaid service provider.
  • Use of audit techniques and procedures to verify the appropriateness of the service provider charges for Medicaid eligible clients/services.
  • Maintenance of audit notes and preparation of a written report summarizing the conclusions reached during the audit.
  • Tracking and monitoring of assigned workload to ensure all due dates are met.
  • Document audit activities and deliverables in external and internal databases.
  • Preparation of exhibits such as analyses, graphs, reports, etc., intended to enhance and clarify any audit, which may be complex and hard to understand.
  • Perform licensing and exclusion reviews on providers and work with the medical staff to ensure services reimbursed meet regulatory requirements.
  • Conduct research on relevant State regulatory support for specific State’s and provider types.
  • Review all applicable State policies and regulations associated to each specific audit assignment or algorithm prior to performing audit.
  • Understand and maintain the ability to apply regulatory support to the audit findings including ensuring that the citation works for the Provider type being audited.
  • Attend on-site audits to retrieve medical records and conduct provider entrance/exit conference.
  • Ensure GAGAS standards are applied to each applicable audit to identify fraud, waste or abuse.
  • Occasionally go into the field to collect, evaluate, and analyze evidence during an ongoing investigation.
  • Occasionally be required to assist in an ongoing investigation by conducting field interviews with investigators of providers and/or beneficiaries or patients witnesses.

Data AnalysisData analysisCommunication SkillsAnalytical SkillsCollaborationMicrosoft ExcelAccounting

Posted 2024-10-15
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