Auditor Compliance Specialist
3 weeks ago
Join the University of Massachusetts Medical School team as an Auditor Compliance Specialist and play a crucial role in combating fraud, waste, and abuse within the Medicaid program.
Job Summary:Under the general direction of the Associate Director or designee, the Auditor Compliance Specialist serves a vital role in conducting desk and onsite reviews based on federal and state regulations that govern provider types. Audits involve extensive research to identify industry trends and patterns in order to detect aberrant billing practices.
Key Responsibilities:- Apply in-depth knowledge of federal and state regulations and healthcare industry standards to conduct independent data mining and data analysis.
- Conduct onsite audits, including reviews of physical plants, member medical records, and employee records.
- Develop reports of investigative findings, compile case file documentation, calculate sanctions and overpayments, and issue findings in accordance with applicable regulations, policies, and procedures.
- Communicate with providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.
- Identify and recommend policy, procedure, and system changes to enhance investigative outcomes and performance.
- Bachelor's degree in business administration, finance, or related field; or equivalent experience.
- 6-8 years of related experience in the healthcare industry, business, accounting, or finance; with at least two years of experience conducting data mining in the healthcare insurance industry, healthcare claim audits, or other claims-related experience.
- Knowledge of the principles and practices of medical auditing.
- Strong analytical and qualitative skills as well as problem-solving skills with the ability to look for root causes and implement workable solutions.
- Master's degree in Business Administration or Public Health.
- Knowledge of coding, reimbursement, and claims processing policies.
- Prefer individual possessing any of the following certifications or licensure: CFE, CPA, RN/LPN, CPC, or CPMA.
This is a hybrid job with a mix of remote and on-site work. The ideal candidate will have excellent communication and interpersonal skills, with the ability to work effectively in a fast-paced environment.
The University of Massachusetts Medical School is an equal opportunity employer and welcomes applications from diverse candidates.
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Shrewsbury, Shropshire, United Kingdom University of Massachusetts Medical School Full timeJob Title: Auditor Compliance SpecialistJoin the University of Massachusetts Medical School team as an Auditor Compliance Specialist and play a crucial role in combating fraud, waste, and abuse in the Medicaid program.Job Summary:Under the general direction of the Associate Director or designee, the Auditor Compliance Specialist will conduct desk and onsite...
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Shrewsbury, Shropshire, United Kingdom University of Massachusetts Medical School Full timeJob Title: Auditor Compliance SpecialistJoin the University of Massachusetts Medical School team as an Auditor Compliance Specialist and play a crucial role in combating fraud, waste, and abuse in the Medicaid program.Job Summary:Under the general direction of the Associate Director or designee, the Auditor Compliance Specialist will conduct desk and onsite...
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