Program Integrity Audit Supervisor

CoventBridge Group

2d•$65,000 - $85,000•Remote

About The Position

Program Integrity Audit Supervisor - REMOTE The Program Integrity Audit Supervisor will primarily be responsible for 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 Medicaid Operations Lead and will work in our Grove City, OH office, or if not local, remotely from a home office.

Requirements

Excellent auditing and leadership skills
Excellent research and organization skills, prioritization, and time management skills
Excellent written and verbal communication skills
Ability to work independently and with minimal supervision
Ability to multi-task in a fast-paced environment
Knowledge of auditing principles, statistics, data analysis techniques, and PC skills are preferred
Bachelor’s Degree or equivalent related experience
Minimum of two (2) years 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

Nice To Haves

Candidates with Certified Fraud Examiner (CFE) Certification will be given priority consideration

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
Ensure audit team meets quality and production standards
Assist in 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
Help establish and maintain relationships within UPIC MW as well as outside stakeholders (i.e., state Medicaid agencies, audit clients, law enforcement agencies, CMS, etc.)
Work closely with the UPIC MW Data Team to understand data analysis projects and their applicability to audits
Work closely with the UPIC MW Medical Review Team to understand their findings and their applicability to audits
Ensure departmental compliance with Quality Management System and ISO requirements
Hire and manage PI staff, responsible for the timely completion of annual employee performance assessments and, when necessary, employee counseling
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
Participating in presenting findings and justifying recommendations in meetings or conferences
Perform other duties as assigned by the PI Manager, Deputy PI Manager, PI Project Manager or Medicaid Operations Lead that contribute to task order goals and objectives