Medicaid Fraud Auditor – Team Lead

Job not on LinkedIn

🔥 13 minutes ago

🦌 Connecticut, Maine, +8 more states – Remote

🦌 Connecticut – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🍁 Vermont – Remote

💵 $66k - $106k / year

⏰ Full Time

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Peraton

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Peraton is a mission-focused enterprise that supports national security initiatives through advanced IT and cyber services. They provide capabilities in areas such as cyber defense, cloud operations, engineering, and intelligence. With a commitment to solving complex challenges, Peraton integrates data-driven technologies to ensure mission success for their military and government clients.

📋 Description

• Oversee the development and progression of Medicaid audits from initiation through completion • Plan audits, conduct audit testing and analysis, develop findings, communicate with providers, and issue final finding reports • Provide day-to-day oversight and direction to Auditors conducting Medicaid audits • Ensure audits are planned, progressed, documented, reviewed, and completed according to federal and state Medicaid requirements and established audit methodologies • Provide technical guidance and consultation on Medicaid requirements, audit methodology, regulatory interpretation, claims analysis, documentation, and findings development • Review individual workloads during monthly auditor meetings, assist with prioritization, and conduct quality control for staff • Establish priorities and monitor staff workloads to align resources with audit requirements and metrics • Monitor the quality of WMM/UCM • Monitor timeliness of audit updates and escalate issues to management as necessary • Mentor team members in identifying previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development • Act as a point of contact for the manager • Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters • Coordinate with other designated leads for coverage when necessary

🎯 Requirements

• Minimum of 8 years with BS/BA; or 12 years with a HS Diploma/equivalent • Experience conducting Medicaid, Medicare, healthcare, compliance, financial, internal, or program integrity audits • Experience leading staff in identifying and documenting noncompliance, improper payments, billing irregularities, or potential overpayments • Strong written, verbal communication and organization skills • Strong PC knowledge and Microsoft Office tools • US Citizen • Direct Medicaid audit or Medicaid Program Integrity experience desirable • Experience researching and applying state-specific Medicaid requirements desirable • Experience auditing hospitals, pharmacies, laboratories, physicians, dental providers, behavioral health providers, personal care providers, managed care organizations, or other Medicaid provider types desirable • Experience with Medicaid provider compliance and billing requirements desirable • Experience identifying Medicaid overpayments desirable • Professional certification such as CPA, CIA, CFE, CHC, CPC, or a comparable audit, fraud, healthcare, or compliance credential preferred • Ability to perform research and draw conclusions • Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government • Ability to organize a case file and accurately and thoroughly document all steps taken • Ability to compose correspondence, reports, and referral summary letters • Ability to educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters • Ability to communicate effectively, internally and externally • Ability to interpret laws and regulations • Ability to exercise independent judgment within established policies, procedures, and audit methodologies • Ability to manage multiple assignments, establish priorities, meet deadlines, and maintain accurate audit documentation • Ability to handle confidential material • Ability to report work activity on a timely basis • Ability to work independently and as a member of a team • Ability to attend meetings, training, and conferences; overnight travel required • Ability to document QC results in WMM according to record type • Ability to coordinate coverage with other designated leads when out of the office

🏖️ Benefits

• Potential eligibility for overtime • Potential eligibility for shift differential • Potential eligibility for a discretionary bonus