Audit Analyst - Medicaid
Briljent•Indianapolis, IN
•Onsite
About The Position
Briljent is seeking an Audit Analyst with multi-functional responsibilities supporting both the Program Integrity Audit Team and the Analytics Team. This role requires flexibility to float between teams as needed and play a key role in Medicaid post-payment audit activities, provider engagement, data analysis, and recovery efforts. The ideal candidate brings strong audit and medical coding experience, a solid understanding of Medicaid policies, and the ability to collaborate effectively with internal teams, state agency staff, and providers.
Requirements
- Ability to manage multiple deadlines and prioritize competing assignments
- Strong analytical and problem-solving skills
- Proficiency with Microsoft Word and Excel
- Excellent verbal and written communication skills
- Highly organized with strong attention to detail and accuracy
- Self-directed with the ability to shift priorities while maintaining productivity
- Collaborative approach and ability to work effectively in a team environment
- Bachelor’s degree in Health Information Administration or a related healthcare field
- 3–5 years of experience in medical coding
- Strong understanding of healthcare claims and code sets (CPT, ICD, HCPCS)
- Experience and knowledge of State and Federal healthcare regulations
Nice To Haves
- Knowledge of Medicaid reimbursement and coverage policies
- Experience working on quality improvement initiatives
- Prior experience supporting audit, utilization review, or program integrity activities
Responsibilities
- Review surveillance and utilization reports; analyze findings and make recommendations
- Perform ad hoc assignments related to Medicaid reimbursement
- Review medical records for accuracy, completeness, and compliance with professional standards
- Develop and maintain working knowledge of Medicaid statutes, regulations, provider billing manuals, and related policies
- Use IHCP policy, audit expertise, and record review experience to recommend new audits and algorithms to improve ROI and increase recoveries
- Interpret and analyze healthcare data to support audit outcomes
- Assist management in developing policies, procedures, workflows, and processes for Audit and Case Disposition functions
- Monitor post-payment audit cases within the case management system and ensure timely follow-up and resolution
- Collaborate with Program Integrity team members to determine case status and final disposition
- Prepare provider demand letters and notifications; ensure appropriate approvals prior to distribution
- Respond to provider inquiries in a prompt, professional, and provider-friendly manner
- Coordinate provider appeals with Audit Vendors as needed
- Assist with notification, tracking, collection, and reporting of overpayment recoveries
- Process provider payments and reconcile monthly recoveries
- Analyze and report collections and un-recoveries for quarterly CMS-64 reporting
- Support configuration, testing, implementation, and ongoing operations of the case tracking system
- Develop educational materials for providers in collaboration with team members
- Identify urgent issues, escalate appropriately, and manage through resolution with clear and timely communication
- Maintain professional working relationships with state agency staff and providers
Benefits
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
