Responsibilities
- Applies comprehensive understanding of federal and state healthcare regulations and industry practices.
- Follows established audit strategies and methodologies aligned with contractual obligations.
- Manages and distributes workloads efficiently while adhering to policy guidelines.
- Analyzes financial records, including provider cost reports, to support audit procedures.
- Uses data analytics and trend identification tools to uncover irregularities in Medicaid billing and disbursements.
- Conducts on-site audits to collect medical documentation and lead provider entrance and exit meetings.
- Drafts and delivers medical record request letters, including those tied to overpayment suspensions.
- Interprets and applies relevant laws, regulations, and policies based on audit findings and provider categories.
- Ensures compliance with Generally Accepted Government Auditing Standards (GAGAS) to detect fraud, waste, or abuse.
- Produces accurate, impartial written reports in line with auditing standards and presents results to stakeholders.
- Determines amounts of improper payments and issues findings, recommendations, and required corrective measures per regulations.
- Issues formal notices of suspended overpayments to providers when appropriate.
- Engages with federal and state agencies and providers on compliance, audit outcomes, and repayment processes.
- Participates in assigned briefings and presentations.
- Upholds quality standards in fraud case development to ensure thorough and actionable case preparation.
- Keeps investigative tools and systems updated with accurate and timely information.
- Maintains case files and databases related to investigative activities.
- Prepares and records investigative reports, compiles case documentation, calculates improper payments, and issues findings and recommendations per applicable rules.
- Conducts research on federal programs, including eligibility, funding, and operational requirements.
- Performs field visits and interviews as needed during investigations.
- Recognizes inefficiencies in existing audit workflows and proposes improvements for better performance.
- Completes additional duties as assigned.
Compensation
Not specified
Work Arrangement
Remote
Team
Full-time
Responsibilities
- Applies comprehensive understanding of federal and state healthcare regulations and industry practices.
- Follows established audit strategies and methodologies aligned with contractual obligations.
- Manages and distributes workloads efficiently while adhering to policy guidelines.
- Analyzes financial records, including provider cost reports, to support audit procedures.
- Uses data analytics and trend identification tools to uncover irregularities in Medicaid billing and disbursements.
- Conducts on-site audits to collect medical documentation and lead provider entrance and exit meetings.
- Drafts and delivers medical record request letters, including those tied to overpayment suspensions.
- Interprets and applies relevant laws, regulations, and policies based on audit findings and provider categories.
- Ensures compliance with Generally Accepted Government Auditing Standards (GAGAS) to detect fraud, waste, or abuse.
- Produces accurate, impartial written reports in line with auditing standards and presents results to stakeholders.
- Determines amounts of improper payments and issues findings, recommendations, and required corrective measures per regulations.
- Issues formal notices of suspended overpayments to providers when appropriate.
- Engages with federal and state agencies and providers on compliance, audit outcomes, and repayment processes.
- Participates in assigned briefings and presentations.
- Upholds quality standards in fraud case development to ensure thorough and actionable case preparation.
- Keeps investigative tools and systems updated with accurate and timely information.
- Maintains case files and databases related to investigative activities.
- Prepares and records investigative reports, compiles case documentation, calculates improper payments, and issues findings and recommendations per applicable rules.
- Conducts research on federal programs, including eligibility, funding, and operational requirements.
- Performs field visits and interviews as needed during investigations.
- Recognizes inefficiencies in existing audit workflows and proposes improvements for better performance.
- Completes additional duties as assigned.
Not specified
