Medicaid Audit and Compliance Specialist
New
United StatesFull-TimeMiddle
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Experience
- 5–7 years
- Required Skills
- Data AnalysisMicrosoft ExcelCompliance
Requirements
- Bachelor’s degree in Finance, Accounting, or a related field.
- 5–7 years of experience in auditing, finance, accounting, or healthcare program integrity roles.
- Strong knowledge of Medicare/Medicaid programs and government auditing standards (GAGAS).
- Experience reviewing medical claims, billing practices, and coding systems (ICD-9, ICD-10, CPT, HCPCS).
- Strong analytical and investigative skills with the ability to interpret complex financial and medical data.
- Familiarity with healthcare compliance frameworks, federal regulations, and payment integrity programs.
- Proficiency in Microsoft Excel and Word, with strong data handling capabilities.
- Excellent written and verbal communication skills, with the ability to produce formal audit documentation.
- Ability to work independently while managing multiple priorities in a deadline-driven environment.
- Strong attention to detail, integrity, and commitment to confidentiality and compliance standards.
Responsibilities
- Conduct Medicaid audits across managed care plans and providers to identify fraud, waste, abuse, and improper payments.
- Apply auditing methodologies in alignment with contractual requirements and Generally Accepted Government Auditing Standards (GAGAS).
- Analyze financial documents, provider cost reports, and claims data to detect inconsistencies and compliance risks.
- Use data mining and trend analysis tools to identify anomalies in Medicaid billing and reimbursement patterns.
- Perform on-site audits, including provider interviews, record retrieval, and entrance/exit conferences.
- Prepare detailed audit reports, findings, recommendations, and corrective action plans for leadership and regulatory stakeholders.
- Communicate with providers and government agencies regarding audit outcomes, compliance issues, and recovery processes.
- Maintain accurate case documentation, investigative records, and timely updates within audit systems and databases.
- Support fraud case development through research, analysis, and documentation of investigative findings.
View Full Description & ApplyYou'll be redirected to the employer's site
