CATHEXIS is seeking a detail-oriented Healthcare Auditor (req-167) to conduct independent, standards-based audits supporting the Department of Veterans Affairs. In this role, you'll apply your expertise to evaluate medical records and claims, supporting the critical mission of preventing fraud, waste, and abuse.
What You'll Do
- Conduct independent and objective evaluation and documentation of observations and findings based on reviews of medical records and claims pertaining to fraud, waste, and abuse.
- Complete medical record reviews using knowledge of medical procedures, Medicare policies, and coding guidelines.
- Utilize coding conventions, detect fraud schemes, evaluate reimbursement practices, and apply laws and regulations to identify fraudulent billing patterns.
- Maintain a thorough understanding of applicable laws, rules, regulations, coding standards, VA policies, and contractual requirements.
- Prepare audit working paper documentation supporting fieldwork and conclusions by GAGAS standards.
- Engage with team members to gather requirements and validate results.
- Work independently and as part of an auditing team to support comprehensive audits of contractors' electronic medical records, documentation, and invoices for Medical Disability Exams.
- Perform other duties as required.
What We're Looking For
- Must have an active Public Trust or the ability to obtain and maintain a Public Trust, which requires U.S. citizenship and a favorable background check.
- A Bachelor’s degree (BS/BA) with three (3) or more years of relevant experience, or a Master’s degree (MS/MA) with no experience required, or certification as a Physical Therapist (or similar licensed medical professional) with four (4) or more years of experience may qualify under a documented waiver process.
- Experience auditing by professional standards and industry best practices.
- Knowledge of government payor practices, guidelines and procedures; knowledge of CPT, ICD-9, ICD-10, and HCPCS coding.
- Excellent communication skills, both written and verbal.
- Proficiency in MS Word, Excel, and PowerPoint.
- Demonstrated ability to work independently and as a team.
- Comfortable managing multiple, variable tasks with limited supervision within targeted timelines in a demanding, quickly changing environment.
Nice to Have
- CPC, CIA, CHC, and/or RHIT Certifications.
Technical Stack
- MS Word
- Excel
- PowerPoint
Team & Environment
You'll work independently and as part of an auditing team to support comprehensive audits.
Benefits & Compensation
- Compensation: $50,000 - $70,000
- Performance Bonuses
- Medical, Dental, and Vision Insurance
- 401(k) Plan (Traditional and ROTH)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off
- 11 Federal Holidays
- Parental Leave
- Commuter Benefits
- Short Term & Long Term Disability
- Training & Development
- Wellness Program
- Community Outreach Initiatives
CATHEXIS is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
