Responsibilities
- Applies comprehensive understanding of federal and state healthcare regulations and industry practices.
- Follows defined audit strategies and methodologies tailored to contractual obligations.
- Manages and distributes workloads while ensuring compliance with task order protocols.
- Analyzes financial records, including provider cost reports, to support audit processes.
- 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 entry and exit meetings.
- Drafts and issues formal medical record requests, including those tied to overpayment suspensions.
- Interprets and implements applicable laws, regulations, and policies related to audit outcomes and provider categories.
- Applies Generally Accepted Government Auditing Standards (GAGAS) to audits to detect fraud, waste, or misuse.
- Produces accurate, impartial reports aligned with professional standards and presents findings to stakeholders.
- Determines improper payment amounts and issues findings, recommendations, and corrective measures per regulatory guidelines.
- Issues formal overpayment suspension notices to providers when warranted.
- Engages with federal and state agencies and providers on compliance matters, audit results, and repayment procedures.
- Participates in assigned briefings and presentations.
- Upholds quality standards in fraud case development to ensure thorough and actionable case preparation.
- Ensures timely and accurate updates in case management systems and investigative tools.
- Maintains investigative databases and documentation.
- Prepares and records investigation reports, compiles case files, calculates improper payments, and issues corrective actions per regulations.
- Conducts research on federal program operations, including eligibility, payments, and compliance requirements.
- Performs field visits and interviews as needed during investigations.
- Identifies inefficiencies in existing audit procedures and proposes improvements for better performance.
- Completes additional duties as assigned.
Work Arrangement
Remote
Team
Collaborative audit team environment with independent responsibilities
Responsibilities
- Applies comprehensive understanding of federal and state healthcare regulations and industry practices.
- Follows defined audit strategies and methodologies tailored to contractual obligations.
- Manages and distributes workloads while ensuring compliance with task order protocols.
- Analyzes financial records, including provider cost reports, to support audit processes.
- 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 entry and exit meetings.
- Drafts and issues formal medical record requests, including those tied to overpayment suspensions.
- Interprets and implements applicable laws, regulations, and policies related to audit outcomes and provider categories.
- Applies Generally Accepted Government Auditing Standards (GAGAS) to audits to detect fraud, waste, or misuse.
- Produces accurate, impartial reports aligned with professional standards and presents findings to stakeholders.
- Determines improper payment amounts and issues findings, recommendations, and corrective measures per regulatory guidelines.
- Issues formal overpayment suspension notices to providers when warranted.
- Engages with federal and state agencies and providers on compliance matters, audit results, and repayment procedures.
- Participates in assigned briefings and presentations.
- Upholds quality standards in fraud case development to ensure thorough and actionable case preparation.
- Ensures timely and accurate updates in case management systems and investigative tools.
- Maintains investigative databases and documentation.
- Prepares and records investigation reports, compiles case files, calculates improper payments, and issues corrective actions per regulations.
- Conducts research on federal program operations, including eligibility, payments, and compliance requirements.
- Performs field visits and interviews as needed during investigations.
- Identifies inefficiencies in existing audit procedures and proposes improvements for better performance.
- Completes additional duties as assigned.
Other
- Position is conducted remotely.
- On-site audit participation may be required.
- Must be capable of working both independently and as part of an audit team.
Not specified
