Top 6 Coding compliance Jobs in Worcester, Ma

Medical Program Auditor/ Analyst
University of Massachusetts Medical School —Worcester, MA
- $80,000 - $95,000 a year
- Full-time
- Microsoft Excel
- Customer service
- Mid-level
Medical Billing Code Auditor- Healthcare Internal Audit - Hybrid work schedule
Fallon Health —Worcester, MA
- $87,500 a year
- Full-time
- Hybrid work
- Writing skills
- Mid-level
- 3 years
Facility Inpatient Coding Auditor
GEBBS HEALTHCARE SOLUTIONS INC —United States
- $18.50 an hour
- Full-time
- Remote
- Mid-level
- 3 years
- Ob/Gyn
- Health insurance
- Dental insurance
Quick Apply

Discover related jobs

Based on your search for coding compliance jobs.

Account and Implementation Manager (SaaS)
MetaComet Systems —Northampton, MA
Bachelor’s degree in business, Computer Science, or a related field. Familiarity with project management methodologies and tools (e.g., Agile, Asana).
$70,000 - $90,000 a year
Quick Apply
Project Manager
Building Evolution Corporation —Worcester, MA
The ideal candidate brings strong building science knowledge, experience with both design review and in-field evaluation of building systems, technical analysis…
$90,000 - $135,000 a year
Quick Apply
5d

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

AVP, Fund Compliance - Mutual Funds
Ultimus Fund Solutions —Columbus, OH
Bachelor’s degree in business administration, finance, or related field. Manages associates within department including, but not limited to, hiring, training,…
$75,000 - $100,000 a year
Quick Apply
Inpatient Coding Auditor
Huron Managed Services LLC —Columbus, OH
This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours…
$38.46 - $52.40 an hour
Quick Apply
4d

Show more jobs in cities nearby

I want to receive the latest job alert for coding compliance in worcester, ma

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

coding compliance jobs near worcester, ma

Auditor jobs in Worcester, MA

Night Auditor jobs in Chicago, IL

Remote Auditor jobs in Pennsylvania

Auditor jobs in Austin, TX

Auditor jobs in Jacksonville, FL

Internal Auditor jobs in Atlanta, GA

Hotel Night Auditor jobs in Phoenix, AZ

It Auditor jobs in Atlanta, GA

It Auditor jobs in Boston, MA

Healthcare Compliance Auditor jobs in Remote

Hotel Night Auditor jobs in San Diego, CA

Internal Auditor jobs in New York, NY

Hotel Night Auditor jobs in Minneapolis, MN

Entry Level Auditor jobs in Washington, DC

Medical Program Auditor/ Analyst

University of Massachusetts Medical School -
Worcester, MA

Apply Now

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

#LI-AC1

Apply Now

Refine Your Search

coding compliance jobs in worcester, ma

Medical Program Auditor/ Analyst

Medical Billing Code Auditor- Healthcare Internal Audit - Hybrid work schedule

Facility Inpatient Coding Auditor

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for coding compliance in worcester, ma

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected