Overview

Program Integrity Audit Analyst II -  REMOTE

 

The Program Integrity Audit Analyst II performs evaluation and development of leads associated with performance audits of Medicaid Managed Care Plans to identify potential fraud, waste, and abuse; issue findings and recommendations; and identify improper payments.

 

In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective:  To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.

 

This position will report directly to the Program Integrity Audit Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office. 

Responsibilities/ Requirements

 Responsibilities: 

• Understanding of state Medicaid programs and managed care plan delivery systems.
• Planning, coordinating, and conducting performance audits in accordance with Government Auditing Standards.
• Understanding managed care encounter data and determining areas that require improved program integrity oversight.
• Designing and implementing audit strategies for performing provider payment reviews and managed care plan performance audits using independent judgment to formulate a plan of action and direction in complex audit scenarios.
• Work with auditors to develop audit plans clearly defining scope, steps, and tasks to achieve stated audit objectives including plans of action for audit development and information request processing.
• Documenting specific findings and recommendations for improved contract compliance and process improvement; and identifying any improper payments with conclusions based on rule, policy, and billing instructions.
• Developing and supporting findings that accurately report condition, criteria, cause, and effect and proposes viable recommendations for corrective actions, as applicable. 
• Prioritization and assignment of workload, ensuring adherence to task order policies and procedures.
• Preparing factual and objective written reports in conformance with professional auditing and evaluation standards.
• Ensure findings are well defined and are fully supportable and required reports are submitted according to pre-established time guidelines.
• Interpret and apply pertinent laws, regulations, policies, and procedures relevant to the specific audit findings.
• Conduct matrix review meetings with auditors to ensure thorough and timely completion of assigned audit tasks in accordance with task order guidelines and direction from CMS.
• Prepare and submit medical record request letters to providers associated with requests for medical record requests or suspension overpayment determinations.
• Serve as mentor/trainer to new Program Integrity staff.
• Perform other duties as assigned by PI Audit Supervisor or the PI Manager, Deputy PI Manager, PI Project Manager, or Medicaid Operations Lead
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Requirements:

• Excellent research and organization, prioritization, and time management skills
• Excellent verbal and written communication skills
• Ability to work independently with minimal supervision
• Ability to multi-task in a fast-paced environment
• Knowledge of statistics, data analysis techniques, and PC skills are preferred
• Experience with an inventory management and reporting system preferred
• Proficiency with Microsoft Word and Excel required

 

Educational/Experience Qualifications:

• High School Diploma or G.E.D. equivalent, with preference given to those candidates who have successfully completed college or technical degree programs related to the position (e.g., Criminal Justice, Statistics, Data Analysis, etc.)
• Candidates with Certified Fraud Examiner (CFE) Certifications will be given priority consideration
• Minimum of one (1) year of experience conducting performance or compliance audits, with preference given to those who have conducted audits involving state Medicaid programs, or one (1) year of experience with an advanced degree preferred

Benefits

• Medical, Dental, Vision plans
• Life, LTD and STD paid by the employer
• 401(k) with company match up to 4%
• Paid Time Off and company paid holidays
• Tuition assistance after 1 year of service

 

The salary range for this role is $60,000 to $70,000 annually.  This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.  

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

 

About Us:

 

CoventBridge Group is the global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs.  The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.

 

CoventBridge is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.

 

CoventBridge is committed to the full inclusion of all qualified individuals.  As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.