Audit Analyst - Medicaid

Briljent•Indianapolis, IN

1d•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