Medicaid Auditor (Full-time, Remote)

About Our Client:

The organization is a women-owned small business specializing in compliance and program integrity support for government and commercial clients. It focuses on preventing and detecting fraud, waste, and abuse in government programs through data analytics, technology solutions, audit, investigation, and medical review.

About the Opportunity:

The MEDICAID AUDITOR is responsible for auditing Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse. This role involves conducting programmatic and financial audits, analyzing billing and payment patterns, and reporting findings to ensure compliance with federal and state regulations. The position plays a key role in safeguarding program integrity by detecting improper payments and ensuring adherence to auditing standards.

Responsibilities:

• Follow auditing plans and methodologies based on contract requirements.
• Prioritize and assign workload according to policies and procedures.
• Examine financial documents like provider cost reports for audit purposes.
• Use data mining and trend analysis to detect anomalies in Medicaid billing.
• Conduct on-site audits including medical record retrieval and provider conferences.
• Prepare and send medical record requests and suspension overpayment determinations.
• Interpret and apply relevant laws, regulations, policies, and procedures.
• Ensure application of Generally Accepted Government Auditing Standards.
• Prepare and present objective audit reports to leadership and external partners.
• Calculate improper payments and recommend corrective actions.
• Communicate with federal/state agencies and providers regarding compliance and audit findings.
• Maintain quality standards in fraud case development and investigation documentation.
• Develop and document investigative findings and case files per regulations.

Requirements:

• Bachelor’s Degree in finance, accounting, or related field.
• 5-7 years of experience in finance, accounting, or auditing.
• Intermediate knowledge of internal audit policies and operating principles.
• Experience auditing Medicare/Medicaid and other government payment programs.
• Knowledge of government accounting principles and Generally Accepted Government Auditing Standards.
• Investigative skills and strong data analysis capabilities.
• Familiarity with medical terminology and billing codes including ICD-9-CM, ICD-10-CM, HCPCS Level II, CPT.
• Experience reviewing claims for billing accuracy, medical review, or fraud case development.
• Strong communication, interpersonal, and organizational skills.
• Ability to maintain confidentiality, meet deadlines, and work independently or in teams.
• Proficiency in Microsoft Word and Excel.
• Must pass post-hire background screening.
• For remote work, reliable internet access required.

Pay Range and Compensation Package:

• U.S. remote annual salary range: $55,000-$75,000.

Benefits & Perks:

• Vacation, sick leave, and paid holidays.
• Health insurance.
• Dental insurance.
• Vision insurance.
• Short- and long-term disability insurance.
• Life insurance.
• Employee assistance plan.
• 401(k) retirement plan.
• Educational benefits.

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.