Medicaid Fraud Auditor

Overview

The organization is seeking a Medicaid Fraud Auditor to support SafeGuard Services (SGS). This role involves conducting data analysis, investigations, and medical review to detect, prevent, deter, reduce, and refer fraud, waste, and abuse.

This position focuses on auditing Medicaid programs to ensure compliance with federal and state requirements and to recover over-payments related to non-compliance.

Responsibilities

• Conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state Medicaid program requirements and recover over-payments for non-compliance.
• Apply intermediate-level subject matter knowledge to solve common business issues of moderately complex scope.
• Perform research, interpret laws and regulations, conduct data analysis, and draw conclusions for assigned projects.
• Conduct compliance audits across varied Medicaid case-types, including audits of claim submissions and ad-hoc focused audits.
• Manage several assignments concurrently; organize and analyze billing patterns.
• Conduct interviews and obtain statements from beneficiaries/recipients and others.
• Develop understanding of the function being audited and 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 updates on audit status.
• Present issues of concern supported by verified data, including regulatory violations and evidence of schemes/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

• Required education/experience:
  • 2 years with BS/BA, or
  • 6 years with a HS diploma.
• Experience in accounting or a 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.
• Strong 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, competencies, geographic location, and business/contract considerations.
• Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

Location

• Telework is available from any state in the US.