Medicaid Auditor/Investigator

Overview

The organization is seeking a Medicaid Auditor/Investigator to support SafeGuard Services (SGS) by conducting audits and reviews of Medicaid programs to ensure compliance with federal and state requirements and to recover over-payments for non-compliance. This is a remote position.

Responsibilities

• Conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state Medicaid program requirements and to recover over-payments for non-compliance.
• Apply intermediate subject matter knowledge to resolve common business issues of moderately complex scope.
• Provide analysis of information and limited project direction input as an informed team member.
• Use independent judgment within defined practices and procedures to determine appropriate action.
• Follow established guidelines and correctly interpret policies.
• Evaluate unique circumstances and make recommendations.
• Research and interpret laws and regulations; perform data analysis and draw conclusions.
• Conduct compliance audits of varied Medicaid case-types, including audits of claim submissions and ad-hoc focused audits.
• Manage multiple assignments concurrently; organize and analyze billing patterns.
• Conduct interviews and obtain statements from beneficiaries/recipients and others.
• Develop understanding of the function to be audited; use business knowledge, analytical skills, and experience to identify findings and recommend improvements.
• Identify compliance exceptions, conflicts of interest, and improper payments.
• Organize case files and accurately document all steps taken.
• Work independently or as part of a team; provide ongoing progress reports and audit status updates.
• Present issues of concern verified through data, citing regulatory violations and identifying schemes or scams to defraud the Government.
• Compose correspondence, reports, and referral summary letters.
• Ensure projects are timely, complete, and accurate.
• Participate in meetings and attend training to further business acumen.

Requirements

• 2 years with BS/BA or 6 years with a HS diploma.
• Experience in accounting or closely related business field, law enforcement, health science or related field.
• Knowledge of internal audit/investigative policies and operating principles.
• Understanding of Medicare/Medicaid or healthcare auditing.
• Strong research and analytical skills.
• Familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel.
• Must be a US Citizen.

Preferred Qualifications

• Intermediate financial and business acumen.
• Intermediate audit/investigative skills.
• Project management skills.
• Knowledge of the healthcare industry and medical coding concepts and/or experience analyzing health care claims data.

Compensation & Benefits

• Target Salary Range: $51,000 - $82,000.
• Salary is determined by factors including scope and responsibilities, experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations.
• Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
• Benefits for eligible employees may include: medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays.

Location

• Remote position.

Application Notes

• The application period is estimated to be 30 days from the job posting date; timing may be shortened or extended based on business needs and candidate availability.
• During application review, candidates may be required to participate in an on-camera interview and a process to verify identity.
• Use of artificial intelligence (AI) tools of any kind during interviews is strictly prohibited unless the candidate has obtained prior written authorization. All interview responses must be the candidate’s own.

Equal Employment Opportunity

Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.