CoventBridge Group ยท 2 weeks ago
Program Integrity Audit Analyst II
United States
Full-time
Remote
Entry, Mid Level
$60K/yr - $70K/yr
1+ years expCoventBridge Group is the global leader in full-service investigations, and they are seeking a Program Integrity Audit Analyst II to perform evaluations and develop leads associated with performance audits of Medicaid Managed Care Plans. This role involves identifying potential fraud, waste, and abuse, issuing findings and recommendations, and ensuring improved healthcare delivery through effective audit strategies.
Customer ServiceOutsourcing
Responsibilities
Understanding of state Medicaid programs and managed care plan delivery systems
Planning, coordinating, and conducting performance audits in accordance with Government Auditing Standards
Understanding managed care encounter data and determining areas that require improved program integrity oversight
Designing and implementing audit strategies for performing provider payment reviews and managed care plan performance audits using independent judgment to formulate a plan of action and direction in complex audit scenarios
Work with auditors to develop audit plans clearly defining scope, steps, and tasks to achieve stated audit objectives including plans of action for audit development and information request processing
Documenting specific findings and recommendations for improved contract compliance and process improvement; and identifying any improper payments with conclusions based on rule, policy, and billing instructions
Developing and supporting findings that accurately report condition, criteria, cause, and effect and proposes viable recommendations for corrective actions, as applicable
Prioritization and assignment of workload, ensuring adherence to task order policies and procedures
Preparing factual and objective written reports in conformance with professional auditing and evaluation standards
Ensure findings are well defined and are fully supportable and required reports are submitted according to pre-established time guidelines
Interpret and apply pertinent laws, regulations, policies, and procedures relevant to the specific audit findings
Conduct matrix review meetings with auditors to ensure thorough and timely completion of assigned audit tasks in accordance with task order guidelines and direction from CMS
Prepare and submit medical record request letters to providers associated with requests for medical record requests or suspension overpayment determinations
Serve as mentor/trainer to new Program Integrity staff
Perform other duties as assigned by PI Audit Supervisor or the PI Manager, Deputy PI Manager, PI Project Manager, or Medicaid Operations Lead
Qualification
Required
Understanding of state Medicaid programs and managed care plan delivery systems
Planning, coordinating, and conducting performance audits in accordance with Government Auditing Standards
Understanding managed care encounter data and determining areas that require improved program integrity oversight
Designing and implementing audit strategies for performing provider payment reviews and managed care plan performance audits using independent judgment to formulate a plan of action and direction in complex audit scenarios
Work with auditors to develop audit plans clearly defining scope, steps, and tasks to achieve stated audit objectives including plans of action for audit development and information request processing
Documenting specific findings and recommendations for improved contract compliance and process improvement; and identifying any improper payments with conclusions based on rule, policy, and billing instructions
Developing and supporting findings that accurately report condition, criteria, cause, and effect and proposes viable recommendations for corrective actions, as applicable
Prioritization and assignment of workload, ensuring adherence to task order policies and procedures
Preparing factual and objective written reports in conformance with professional auditing and evaluation standards
Ensure findings are well defined and are fully supportable and required reports are submitted according to pre-established time guidelines
Interpret and apply pertinent laws, regulations, policies, and procedures relevant to the specific audit findings
Conduct matrix review meetings with auditors to ensure thorough and timely completion of assigned audit tasks in accordance with task order guidelines and direction from CMS
Prepare and submit medical record request letters to providers associated with requests for medical record requests or suspension overpayment determinations
Serve as mentor/trainer to new Program Integrity staff
Perform other duties as assigned by PI Audit Supervisor or the PI Manager, Deputy PI Manager, PI Project Manager, or Medicaid Operations Lead
Excellent research and organization, prioritization, and time management skills
Excellent verbal and written communication skills
Ability to work independently with minimal supervision
Ability to multi-task in a fast-paced environment
Proficiency with Microsoft Word and Excel required
High School Diploma or G.E.D. equivalent, with preference given to those candidates who have successfully completed college or technical degree programs related to the position (e.g., Criminal Justice, Statistics, Data Analysis, etc.)
Minimum of one (1) year of experience conducting performance or compliance audits, with preference given to those who have conducted audits involving state Medicaid programs, or one (1) year of experience with an advanced degree preferred
Preferred
Knowledge of statistics, data analysis techniques, and PC skills are preferred
Experience with an inventory management and reporting system preferred
Candidates with Certified Fraud Examiner (CFE) Certifications will be given priority consideration
Benefits
Medical, Dental, Vision plans
Life, LTD and STD paid by the employer
401(k) with company match up to 4%
Paid Time Off and company paid holidays
Tuition assistance after 1 year of service
Company
CoventBridge Group
oventBridge Group is a full service investigation company
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Doug Merriman
Chief Executive Officer, Chief Operating Officer, President
Recent News
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