Medicaid Fraud Auditor

🔥 1 hour 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

🟡 Mid-level

🟠 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.

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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

• Research and interpret federal and state Medicaid requirements • Develop appropriate audit procedures • Analyze claims and supporting documentation • Identify and substantiate exceptions • Determine potential overpayments • Communicate audit conclusions clearly • Conduct Medicaid compliance, payment, provider, and focused audits across varied provider types, services, and program requirements • Independently perform audits from planning and procedure development through testing, analysis, findings, and completion • Research statutes, regulations, Medicaid manuals, provider requirements, policies, and other applicable guidance • Develop audit testing procedures addressing identified risks and Medicaid requirements • Analyze claims, payment data, medical or service documentation, financial records, provider records, and other information • Calculate or validate potential Medicaid overpayments • Evaluate complex circumstances and exercise professional judgment • Develop well-supported audit findings identifying requirements, conditions, evidence, and financial impact • Maintain complete and accurate audit workpapers and case files • Conduct interviews and obtain information from providers, beneficiaries/recipients, and other relevant individuals • Prepare audit reports, Law Enforcement referral summaries, and other written products • Support Lead and Manager as needed and mentor new staff • Participate in meetings and attend training

🎯 Requirements

• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD • Bachelor's degree in accounting, finance, business, healthcare administration, public health, health science, law, or a related field, or an equivalent combination of education and relevant professional experience • Experience conducting Medicaid, Medicare, healthcare, compliance, financial, internal, or program integrity audits • Experience independently planning, conducting, documenting, and completing audits or complex reviews • Ability to research and interpret laws, regulations, policies, contractual requirements, and other authoritative guidance and apply those requirements to audit findings • Experience analyzing healthcare claims, billing records, financial information, medical/service documentation, or other provider records • Experience identifying and documenting noncompliance, improper payments, billing irregularities, or potential overpayments • Strong written communication skills and ability to prepare professional audit correspondence, findings, reports, and technical documentation • Strong analytical, organizational, research, and problem-solving skills • 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 • Intermediate to advanced proficiency with Microsoft Excel, Word, and PowerPoint • Must be a US Citizen • Direct Medicaid audit or Medicaid Program Integrity experience • Experience researching and applying state-specific Medicaid requirements • Experience auditing hospitals, pharmacies, laboratories, physicians, dental providers, behavioral health providers, personal care providers, managed care organizations, or other Medicaid provider types • Experience with Medicaid provider compliance and billing requirements • Experience identifying Medicaid overpayments • Professional certification such as CPA, CIA, CFE, CHC, CPC, or a comparable audit, fraud, healthcare, or compliance credential

🏖️ Benefits

• Eligible for overtime, shift differential, and a discretionary bonus in addition to base pay • Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law