Top 17 Medical program auditor/ analyst Jobs in Waltham Ma

Medical Program Auditor/ Analyst
University of Massachusetts Medical School —Westborough, MA
- $80,000 - $95,000 a year
- Full-time
- Microsoft Excel
- Customer service
- Mid-level
IT Internal Audit Analyst
Teradyne —North Reading, MA
- $85,200 - $136,400 a year
- Oracle
- 5 years
- Mid-level
- Paid holidays
- Disability insurance
NetSuite Systems Analyst
Evolv Technologies Inc. —Waltham, MA
- $102,000 - $166,000 a year
- Full-time
- Hybrid work
- Office
- Analysis skills
- Continuous improvement
- Health savings account
- Health insurance
Quick Apply
Senior Aladdin Performance Analyst
Citi —Boston, MA
- $123,360 - $185,040 a year
- Full-time
- Hybrid work
- 6 years
- Writing skills
- Office
- Paid holidays
- Disability insurance
Finance Operations Analyst I
Point32Health —Canton, MA
- $54,712.80 - $82,069.20 a year
- Full-time
- Office
- Bachelor's degree
- Accounting
- Disability insurance
- Health insurance
10d
Senior IT Business Analyst, GLP & GMP
Wave Life Sciences —Lexington, MA
- $127,000 - $172,000 a year
- Full-time
- 5 years
- Bachelor of Science
- Office
- Employee stock purchase plan
- Disability insurance
IT Risk & Compliance Analyst
Watts Regulator Company —Andover, MA
- $84,000 - $94,000 a year
- Full-time
- Mid-level
- Residential
- 3 years
- Paid parental leave
- Paid holidays
Quick Apply
Senior Tax Analyst
Global Partners —Newton, MA
- $89,700 - $134,600 a year
- Full-time
- Oracle
- Research
- Mid-level
- Health insurance
- Dental insurance
Financial Reporting Analyst, US Funds
Wellington Management —Boston, MA
- $80,000 - $150,000 a year
- Email
- 5 years
- Mid-level
- Office
- Commuter assistance
- Health savings account
Financial Analyst or Senior Financial Analyst – West Michigan | Full Relocation Package Offered
Augmentis —Boston, MA
- $90,000 - $135,000 a year
- Full-time
- Oracle
- Mid-level
- Office
- Relocation assistance
- Health insurance
Quick Apply
3d
Director of Revenue & Reimbursement
Dana-Farber Cancer Institute —Brookline, MA
- $177,500 - $205,500 a year
- Full-time
- Finance
- Master's degree
- Bachelor's degree
Lead Business Systems Analyst - SAP FICO
Broad Institute —Cambridge, MA
- $104,000 - $145,333 a year
- Full-time
- 3 years
- Finance
- Bachelor's degree
- Health savings account
- Paid holidays
Director of Treasury
Dana-Farber Cancer Institute —Brookline, MA
- $188,500 - $207,400 a year
- Full-time
- 5 years
- Office
- Master's degree
SVP, Commercial Lending
First Technology Federal Credit Union —Marlborough, MA
- $270,000 - $310,000 a year
- Email
- Bachelor's degree
- Mentoring
- Experience equivalent to degree accepted
- Paid holidays
- Health insurance
Quick Apply
Energy Efficiency Engineer
Abraxas Energy Consulting LLC —Billerica, MA
- $100,000 - $130,000 a year
- Urgently hiring
- Microsoft Word
- Bachelor of Science
- English
- Health insurance
- Dental insurance
Quick Apply
Director of Information Security Engineering
Leader Bank —Arlington, MA
- $170,000 - $220,000 a year
- Full-time
- Azure
- Computer Science
- AWS
- Wellness program
- Paid holidays
Quick Apply
Program Director 340B
Mass General Brigham Incorporated —Somerville, MA
- $124,342.40 - $180,897.60 a year
- Full-time
- Hybrid work
- Office
- Master's degree
- Bachelor's degree
- Benefits from day one
- Opportunities for advancement
Quick Apply

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medical program auditor/ analyst jobs near waltham ma

Medical Program Auditor/ Analyst

University of Massachusetts Medical School -
Westborough, MA

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Job Details

Full-time
$80,000 - $95,000 a year

Qualifications

Customer communication
Bachelor's degree
Data-driven problem-solving

Full Job Description

Overview:

Under the general direction of the Associate Director or designee, the Fraud, Waste, and Abuse (FWA) Auditor serves a crucial role in identifying, investigating, and preventing fraud, waste and abuse for Medicaid programs. A major function of this position is to conduct desk and onsite audits across various provider types to ensure compliance with federal and state regulations. The Auditor performs investigative activities to develop leads and detect aberrant billing practices, including data mining, claims analysis, and medical record assessment.

Onsite requirement 1-2 times per month, all other aspects of the job are remote.

Responsibilities:

Responsibilities:

Ensure compliance with federal and state regulations and healthcare FWA industry standards.
Perform independent data mining and data analysis utilizing claims data to detect patterns and trends that may uncover fraud, waste, or non-compliant billing practices.
Conduct onsite audits as required, to assess the completeness of medical and administrative records and the compliance with applicable regulatory requirements.
Prepare detailed audit documentation, summaries of investigative findings, compile case files, calculate sanctions and overpayments based on violations cited.
Communicate with providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.
Recommend policy, procedure and system changes to enhance investigative outcomes.
Update appropriate internal management staff regularly on progress of investigations.
Stay current with regulatory updates, coding changes, and industry standards.
Identify trends from national fraud-related publications and recommend new or improved strategies to strengthen fraud-detection efforts.
Assist with document management, updating case-tracking system and adhering to record retention policies and procedures.
Perform other duties as assigned.

Qualifications:

Qualifications:

Bachelor's degree in business, health care administration, or other related field
4-6 years of related experience in the healthcare industry, business,; with at least two years of experience conducting data mining in the healthcare insurance industry, healthcare claim audits, administrative medical record reviews or other claims analysis related experience
Knowledge of CPT, HCPCS and ICD-10 coding, reimbursement and claims processing policies
Strong analytical and qualitative skills as well as problem solving skills with the ability to look for root causes and implement workable solutions
Ability to interpret and apply law and regulations as it relates to fraud and fraud investigations
Ability to multi-task, establish priorities and work independently and collaboratively to achieve audit objectives
Proficiency in Microsoft Office applications (Word, Excel, PowerPoint and Access)
Excellent Customer service skills with the ability to interact professionally and effectively with providers, clients, and internal stakeholders from all departments
Ability to travel within Massachusetts and be on-site as needed for audits

Additional Information:

Preferred Qualifications:

Prefer individual possessing any of the following certifications or licensure: CPC or CPMA
Knowledge of state and federal regulations as they apply to public assistance programs

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medical program auditor/ analyst jobs in waltham ma

Medical Program Auditor/ Analyst

IT Internal Audit Analyst

NetSuite Systems Analyst

Senior Aladdin Performance Analyst

Finance Operations Analyst I

Senior IT Business Analyst, GLP & GMP

IT Risk & Compliance Analyst

Senior Tax Analyst

Financial Reporting Analyst, US Funds

Financial Analyst or Senior Financial Analyst – West Michigan | Full Relocation Package Offered

Director of Revenue & Reimbursement

Lead Business Systems Analyst - SAP FICO

Director of Treasury

SVP, Commercial Lending

Energy Efficiency Engineer

Director of Information Security Engineering

Program Director 340B

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