Staff Auditor I executing financial, operational, compliance, and IT audits while improving risk management processes. Collaborating with stakeholders and reporting findings for enhanced effectiveness.
About the role
- Program Integrity Auditor in health compliance auditing provider records for adherence to regulations. Conducting post-payment audits and educating providers on compliance.
Responsibilities
- Conduct routine and targeted post-payment audits of Medicaid and State funded providers
- Develop audit plans and tools based on services to be audited
- Request and/or collect medical records and other documents from providers
- Identify inappropriate billing and improper payments
- Document audit activities and findings in a detailed report
- Present audit results to leadership and Compliance Committee
- Conduct due diligence reviews of newly enrolled providers
- Research clinical policies and federal/state laws for noncompliance
- Analyze data from various sources to inform decision making
- Educate providers on errors identified in the audit process
- Document Improper Payment Charts and provide feedback to providers
- Prepare for and participate in provider appeal process and/or court hearings
Requirements
- Bachelor’s degree in health care compliance, analytics, government/public administration, auditing, security management, criminal justice, or pre-law
- Three (3) years of post-degree experience in healthcare compliance, regulatory analysis, policy development, auditing, investigations, accreditation
- Health care industry and/or Medicare/Medicaid/Behavioral Health knowledge preferred
- Certification from AHFI, CFE, CPMA, CPC, CHC, or equivalent preferred
- Clinical license as an LCSW, LCMHC, LMFT, LCAS, or LPA preferred
- Knowledge of Alliance Health service benefit plans and network providers
- Knowledge of state and federal Medicaid laws, criminal and civil fraud laws
- Proficiency in claims adjudication standards & procedures
Benefits
- Medical
- Dental
- Vision
- Life
- Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
Job title
Job type
Experience level
Salary
Degree requirement
Location requirements
Internal Auditor for PromptCare Companies responsible for managing documents and audits. Ensuring compliance and communication with team, enhancing documentation processes.
Assistant Tax Auditor in Athens with Forvis Mazars collaborating on tax audit engagements and developing technical knowledge in tax compliance.
Internal Staff Auditor conducting audits related to payments and the card industry at Fiserv. Collaborating with business departments to ensure compliance with policies and regulations.
Supplier Quality Audit Lead managing GMP and Quality Systems compliance audits for GSK manufacturing suppliers. Responsible for maintaining supplier compliance and effective communication with stakeholders.
Doc Auditor responsible for processing and reviewing closing - related documentation at ServiceLink. Supports Doc Auditors and ensures compliance with company and client requirements.
Conducting premium audits for various coverage lines including Workers Compensation and General Liability. Ensuring compliance and maintaining regulatory standards as part of the audit process.
Business Process Auditor Associate providing assurance and advisory services within a health plan environment. Gaining experience in evaluating governance, risks, and controls across health plan operations.
Associate Auditor participating in audits and compliance reviews for Travelers. Identifying risks and executing specific testing procedures under moderate supervision.
ISO Lead Auditor/Consultant conducting consultancy assignments for IMSM, a global ISO consultancy. Remote delivery with occasional on - site visits and flexible work arrangements.