Healthcare Auditor (contingent)

We are seeking a dynamic Healthcare Auditor to join our team at Team CATHEXIS. The Healthcare Auditor will be responsible for conducting independent and objective evaluations of medical records and claims to identify fraud, waste, and abuse. The successful candidate will be detail-oriented, capable of working independently, and able to complete objective evaluations. In addition, the Healthcare Auditor will be expected to actively participate in audit team post-audit reviews and planning sessions. This role will support the Department of Veterans Affairs in the Financial Audit of Invoices and Billing Practices under VA's Medical Disability Examination Contracts.

• Responsible for independent and objective evaluation of medical records and claims as it pertains to fraud, waste and abuse
• Complete proactive medical record reviews using knowledge of medical procedures, Medicare policies, coding guidelines, etc.
• Utilize coding conventions, detection of fraud schemes, evaluation of reimbursement practices, and application of pertinent laws, rules and regulations to identify fraudulent billing patterns in claims, documentation, authorization for services, etc.
• Maintain thorough understanding of applicable laws, rules, regulations, coding and billing standards, VA policies and contractual provisions, and related requirements necessary to perform criteria-based audits
• Prepare audit working paper documentation supporting fieldwork and conclusions in accordance with GAGAS standards
• Assist in preparing written summaries of audit fieldwork results and conclusions for inclusion in formal written audit reports
• Engage with customers, audited entities, and team members to gather requirements and validate results
• Perform root-cause analysis; and identify corrective and preventative actions and opportunities for improvement
• The Auditor works independently and as part of an auditing team, supporting comprehensive audits of contractors’ electronic medical records, other documentation, and invoices. The audits are of vendors who provide Medical Disability Exams in support of the Department of Veteran Affairs.

• Detail-oriented and capable of working independently
• Able to complete objective evaluations of medical records and claims
• Knowledge of medical procedures, Medicare policies, and coding guidelines
• Familiarity with coding conventions and detection of fraud schemes
• Understanding of applicable laws, rules, regulations, and billing standards
• Ability to prepare audit working paper documentation and written summaries of audit fieldwork results
• Strong communication and engagement skills with customers, audited entities, and team members
• Root-cause analysis and identification of corrective and preventative actions
• Registered nurse or other licensed medical professional, BS in Business Administration or Healthcare Administration, or 5 or more years of relevant experience in lieu of a degree

• Comprehensive audits of contractors' electronic medical records, other documentation, and invoices
• Engaging with customers, audited entities, and team members
• Performing root-cause analysis and identifying corrective and preventative actions
• Working independently and as part of an auditing team
• Opportunity for improvement
• Excellent communication skills
• Proficiency in MS Word, Excel, and PowerPoint
• Ability to work independently and as a team
• Comfortable managing multiple tasks with limited supervision
• Equal Employment Opportunity
• No discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status
• Reasonable accommodation for individuals with disabilities