Medicaid Audit and Compliance Specialist UPIC SE in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Medicaid Audit and Compliance Specialist UPIC SE in the United States.

This role is a detail-oriented audit and compliance position focused on supporting the integrity of Medicaid programs through the detection and prevention of fraud, waste, and abuse. You will be responsible for conducting complex audits across Medicaid Managed Care Plans and healthcare providers, ensuring adherence to federal and state regulations. The position involves a mix of desk-based analysis and on-site audit activities, including medical record reviews, financial data assessments, and provider compliance evaluations. You will leverage data analytics and investigative tools to identify anomalies in billing patterns and potential improper payments. Working independently and collaboratively, you will prepare formal audit reports, document findings, and recommend corrective actions. This is a mission-driven role ideal for professionals who combine analytical rigor with a strong commitment to program integrity and healthcare compliance.

• Conduct Medicaid audits across managed care plans and providers to identify fraud, waste, abuse, and improper payments.
• Apply auditing methodologies in alignment with contractual requirements and Generally Accepted Government Auditing Standards (GAGAS).
• Analyze financial documents, provider cost reports, and claims data to detect inconsistencies and compliance risks.
• Use data mining and trend analysis tools to identify anomalies in Medicaid billing and reimbursement patterns.
• Perform on-site audits, including provider interviews, record retrieval, and entrance/exit conferences.
• Prepare detailed audit reports, findings, recommendations, and corrective action plans for leadership and regulatory stakeholders.
• Communicate with providers and government agencies regarding audit outcomes, compliance issues, and recovery processes.
• Maintain accurate case documentation, investigative records, and timely updates within audit systems and databases.
• Support fraud case development through research, analysis, and documentation of investigative findings.

Requirements:

• Bachelor’s degree in Finance, Accounting, or a related field.
• 5–7 years of experience in auditing, finance, accounting, or healthcare program integrity roles.
• Strong knowledge of Medicare/Medicaid programs and government auditing standards (GAGAS).
• Experience reviewing medical claims, billing practices, and coding systems (ICD-9, ICD-10, CPT, HCPCS).
• Strong analytical and investigative skills with the ability to interpret complex financial and medical data.
• Familiarity with healthcare compliance frameworks, federal regulations, and payment integrity programs.
• Proficiency in Microsoft Excel and Word, with strong data handling capabilities.
• Excellent written and verbal communication skills, with the ability to produce formal audit documentation.
• Ability to work independently while managing multiple priorities in a deadline-driven environment.
• Strong attention to detail, integrity, and commitment to confidentiality and compliance standards.

Benefits:

• Competitive compensation package aligned with experience and expertise.
• Fully remote work with required reliable internet connectivity.
• Opportunity to contribute to healthcare program integrity and fraud prevention initiatives.
• Professional development in government auditing, compliance, and healthcare analytics.
• Collaborative and mission-driven work environment focused on public service impact.
• Exposure to federal and state regulatory frameworks and advanced audit methodologies.
• Supportive culture emphasizing flexibility, autonomy, and work-life balance.