Senior Lead Auditor responsible for conducting audits against relevant standards at Bureau Veritas. Coordinating audit processes and ensuring compliance with regulatory requirements.
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
Senior Analyst conducting fraud investigations for Oscar Health, focusing on healthcare claims and member enrollment data. Managing investigations with autonomy and meeting caseload metrics.
Senior Internal Auditor / Internal Audit Manager at PPRO responsible for audit coverage of regulated entities. Empowering partners to access new markets through local payment methods.
Night Auditor in a JUFA Hotel responsible for guest reception and inquiries. Ensuring a smooth process at the reception and providing excellent service to guests.
IT Auditor ensuring strong IT controls and cybersecurity for clients at PwC Australia. Leading audit engagements, assessing risks, and collaborating across teams to enhance IT frameworks.
(Senior) KI Auditor role at Wavestone combining internal audit tasks and AI analytics. Focused on developing efficient internal controls through modern AI technologies.
Senior Executive Surgery Coder with 3+ years of coding experience required for healthcare analytics company. Must have CPC certification and strong communication skills in Chennai, India.
Auditor responsible for conducting quality audits in nursing homes in Germany. Ensuring compliance with quality standards and providing employee training.
Junior Medical Auditor at Sami analyzing medical accounts and ensuring compliance with healthcare regulations. Collaborating with teams to improve healthcare services and processes.
Internal Auditor at University of Alberta leading independent reviews and providing audit - related advice. Requires extensive audit experience and ability to work independently on complex assignments.