Senior Internal Auditor conducting audits for Hiscox Group in actuarial and insurance domains. Leading audit reviews and supporting team collaboration for effective risk management.
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 Auditor leading audit work for Hancock Whitney's Internal Audit Department. Responsible for risk assessments, financial evaluations, and compliance oversight.
Senior Internal Auditor conducting comprehensive audits to improve internal controls and processes at ICW Group. Evaluating risks and compliance for operational efficiency.
Auditor I performing financial, operational, and compliance audits for county governments in Oklahoma. Requires a bachelor's degree in accounting or two years of related experience.
Technology Regulatory Consultant joining a global tech advisory team to assess controls and boost compliance. Supporting diverse projects with ongoing training and international opportunities.
Senior Internal Auditor at Signet Jewelers evaluating internal controls and participating in integrated audits. Requires local presence in Akron, OH for hybrid work arrangement.
Energy Auditor conducting energy assessments according to DIN EN 16247 and ISO 50001 in Rheinland. Collaborating with clients to identify efficiency measures and generate audit reports.
Elite Premium Insurance Auditor conducting physical and remote audits for EXL's Insurance Premium Audit Group. Engaging with insured businesses to collect and analyze audit - related data.
Nurse Auditor in Brasília analyzing hospital accounts, preparing reports, and performing clinical monitoring. Requires nursing degree and expertise in health regulations.
Assistente GRC e Auditoria Interna evaluating risk management and internal controls for MCS Markup. Supporting IT governance and efficiency through technology tools in a hybrid work environment.