Position Summary
The Medicaid Auditor will ensure timely and accurate submission of requested records. Track, document, and reconcile all audit requests and outcomes. Coordinate and manage the appeals and denials process. Analyze audit and denial trends to identify systemic risks and inform compliance strategy.
This role will serve as the primary point of contact for external audits, ensuring timely and accurate submission of requested records. This is an individual contributor role and does not include people management responsibilities.
Essential Duties and Responsibilities
- Manage auditing of reimbursement issues, including claims.
- Perform miscellaneous compliance audits.
- Oversee tracking, documentation, and reconciliation of all audit requests and outcomes.
- Coordinate and manage the appeals and denials process, ensuring deadlines are met and documentation is complete.
- Analyze audit and denial trends to identify systemic risks and inform compliance strategy.
- Perform assessments of risk related to health care reimbursement through third party payers, particularly Medicaid and managed care payers.
- Maintain strict confidentiality in accordance with HIPAA regulations and company policies.
- Other duties as assigned by leadership.
Required Qualifications
- Bachelor’s degree in healthcare or commensurate experience.
- 3+ years of experience working with Medicaid and/or third-party payers and auditing.
- Strong knowledge of Medicaid regulations.
- Proficiency in technology systems and Microsoft Office programs.
- Ability to maintain confidentiality.
- Excellent written and verbal communication skills.
- Strong organizational skills and ability to manage multiple projects, deadlines, and recurring deliverables.
- Ability to work independently, take direction, and adapt to shifting business priorities.
- Strong attention to detail and follow-through.
- Ability to collaborate effectively across departments without direct authority.
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- Do you have 3 years' experience working with Medicaid?
Work Location: In person
