Top 28 certified fraud examiner Jobs in remote

SME - Medicaid Program Integrity and Claims Audits
BerryDunn —Remote
- $120,000 - $140,000 a year
- Full-time
- Bachelor of Science
- Research
- Analysis skills
- Dental insurance
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- Full-time
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- 5 years
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Qlarant —Remote
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- Bachelor's degree
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- Online Application
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Senior Internal Controls Analyst
Devoted Health —Remote
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- Full-time
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- CPA
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- 3 years
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Sr. Program Integrity Analyst
HHAeXchange —Remote
- $130,000 - $155,000 a year
- Full-time
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IT Auditor
Ferguson Enterprises, LLC —Richmond, VA
- $5,608.34 - $8,975.00 a month
- Full-time
- Remote
- Oracle
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Senior Auditor
Contact Government Services, LLC —Remote
- $80,000 - $150,000 a year
- Full-time
- Hybrid work
- CPA
- 5 years
- Analysis skills
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SIU Healthcare Investigator (Full-time, Remote)
Integrity Management Services, Inc. —Alexandria, VA
- Full-time
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- Microsoft Excel
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- Mid-level
Quick Apply
3d
FWA Special Investigations Unit (SIU) Investigator
Summa Health —Akron, OH
- $28.10 - $42.15 an hour
- Full-time
- Remote
- Microsoft Office
- Analysis skills
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- AD&D insurance
- Disability insurance
2d
Forensic Accountant, Manager/Partner
YA Group —Remote
- Full-time
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- CPA
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Senior Specialist, Coding Auditor
Oscar Health —Remote
- $58,870 - $85,853 a year
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- HIPAA
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6d
Senior Fraud Analyst
C2 Alaska, LLC —Washington, DC
- Up to $61 an hour
- Full-time
- Remote
- 6 years
- Writing skills
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Mortgage Fraud Investigator
Cornerstone Capital Bank, SSB —Denver, CO
- Remote
- 5 years
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- Mid-level
- Paid parental leave
- Health savings account
14d
AML Senior Investigator I - Special Investigations Unit
Information Technology Senior Management Forum —McLean, VA
- $74,200 - $84,700 a year
- Email
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- Research
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- High school diploma or GED
- Health insurance
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8d
Sr. Compliance Specialist - Payment Integrity
Valenz —Remote
- Full-time
- Remote
- Nursing
- 5 years
- Finance
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Healthcare Program Integrity Solutions Consultant
Commence —Virginia Beach, VA
- $150,000 - $165,000 a year
- Online Application
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- Bachelor's degree
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Internal Audit, Senior Director
Feed the Children —Oklahoma City, OK
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- Remote
- Spanish
- CPA
- English
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Retirement & Wealth - Compliance Analyst (Remote)
Inspira Financial Trust, LLC —Oak Brook, IL
- $65,000 - $75,000 a year
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health savings account
- Paid holidays
4d
Sr Director, Financial Crimes Compliance
Cornerstone Capital Bank, SSB —Houston, TX
- Remote
- Office
- Finance
- 8 years
- Paid parental leave
- Health savings account

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certified fraud examiner jobs near remote

SME - Medicaid Program Integrity and Claims Audits

BerryDunn -
Remote

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Job Details

Full-time
$120,000 - $140,000 a year

Benefits

Dental insurance

Qualifications

Customer communication
AI tools proficiency
Machine intelligence
Medicaid regulations
Medicaid

Full Job Description

Overview:

BerryDunn is seeking a Senior Consultant with subject matter expertise in Medicaid program integrity and claims audits to assist clients with prevention and detection of fraud, waste, and abuse. This individual will be responsible for assisting with risk assessment, external audit coordination, interpretation and application of Medicaid policy and applicable code of federal regulations, and conducting Medicaid medical, dental, behavioral health, and pharmacy claims audits.

You will work remotely, hybrid, or in one of our offices, mainly helping client in Guam. You will report to and partner with Government Assurance Practice Group management team members for both client work and career development. With a growth mindset, you will drive your own development with support from our management team.

Travel Expectations: Travel to client sites can range up to 50%.

You Will:

Establish and monitor Medicaid program integrity objectives, and key performance indicators (KPIs).
Ensure the Medicaid program integrity policies and procedures meet federal and state policies and grants compliance.
Research Medicaid policies and regulations.
Advise and assist clients in translating Medicaid policy and program needs into system requirements and change requests, ensuring the State’s program, policy, and business objectives are accurately captured using industry-standard language.
Provide frequent, clear, and consistent communication to the client, team members, and vendors.
Develop or update policies and procedures related to Medicaid program integrity.
Develop corrective action plans to solve program problems.
Analyze Medicaid program integrity reports.
Assist in the development and train the agency on program requirements.
Serve as a senior systems advisor with a strong understanding of the system implementations.
Review and audit Medicaid claims for accuracy, legality, and reasonableness
Make accurate and informed recommendations on claims based on Medicaid policies and regulations and claims data.
Document and report audit findings to management
Stay up-to-date with changes in Medicaid regulations and industry trends
Medicaid systems research and analysis, including but not limited to, member benefit groups, billing codes, system configuration, service limits, system requirements, and electronic billing standards.
Provide quality assurance reviews of work completed by peers

You Have:

Excellent communication skills
Ability to conduct research and analysis related to Medicaid policies.
Medical claims billing or adjudication experience.
Strong communication skills and attention to detail.
Bachelor's Degree (BA/BS)—May substitute four years of applicable experience for degree.
Knowledgeable in quality assurance/control procedures and demonstrated proactive problem management skills.
Demonstrated ability to excel in a team setting.
Strong experience with Microsoft applications and artificial intelligence
Willingness to travel
Willingness to work flexibly to serve clients in different time zones

Preferred Qualifications:

Prior consulting experience in a national or regional consulting firm, and experience working in/with a state Medicaid agency
Experience with government agencies, ideally working with Medicaid program integrity units
Experience with fraud risk assessments
Experience with internal audits
Preference will be given to candidates with any of the following certifications:
- Certified Professional Coder (CPC) or equivalent
- Certified Fraud Examiner (CFE) or equivalent
- Certified Professional Medical Auditor (CPMA) or equivalent.
- Certified Internal Auditor (CIA) or equivalent

Compensation Details:

The base salary range targeted for this role is $120,000 - 140,000. This salary range represents BerryDunn’s good faith and reasonable estimate of the range of possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications more than the minimum requirements for this posting, that applicant is encouraged to apply, and a final salary range may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case. The salary of the finalist selected for this role will be based on a variety of factors, including but not limited to, years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations.

BerryDunn Benefits & Culture:

Our people are what make BerryDunn special, and in return we strive to support our employees and help them thrive. Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn.

We will ensure that individuals are provided reasonable accommodation to participate in the job application or interview process or perform essential job functions. Please contact [email protected] to request an accommodation.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

About BerryDunn

BerryDunn is the brand name under which Berry, Dunn, McNeil & Parker, LLC and BDMP Assurance, LLP, independently owned entities, provide services. Since 1974, BerryDunn has helped businesses, nonprofits, and government agencies throughout the US and its territories solve their greatest challenges. The firm’s tax, advisory, and consulting services are provided by Berry, Dunn, McNeil & Parker, LLC, and its attest services are provided by BDMP Assurance, LLP, a licensed CPA firm.

BerryDunn is a client-centered, people-first professional services firm with a mission to empower the meaningful growth of our people, clients, and communities. Led by CEO Sarah Belliveau, the firm has been recognized for its efforts in creating a diverse and inclusive workplace culture, and for its focus on learning, development, and well-being. Learn more at berrydunn.com.

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Refine Your Search

certified fraud examiner jobs in remote

SME - Medicaid Program Integrity and Claims Audits

Senior Investigator (Healthcare FWA)

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