Senior Medical Audit Specialist
About The Position
The Senior Medical Audit Specialist plays a critical role in safeguarding the integrity of healthcare services by providing clinical expertise in conducting audits and investigations to combat fraud, waste, and abuse. This position ensures compliance with OHCA policies, state statutes, and federal regulations through detailed analysis of billed services and documentation. By collaborating with internal and external stakeholders, the Senior Medical Audit Specialist helps to promote accountability and transparency in billing practices, supporting the overall mission of the Oklahoma Health Care Authority to provide better health and care for Oklahomans.
Requirements
- Current professional license as a Registered Nurse (RN)
- General understanding of coding principles (CPT, HCPCS, ICD-10 and /or DRG)
- The best-fitting Korn Ferry competencies for this position include Ensures Accountability, as the role focuses on enforcing compliance and managing responsibilities, and Collaborates, given the need for cross-functional teamwork and stakeholder engagement.
- To be considered for this position your application must include a resume/CV with complete work and education history.
Nice To Haves
- Certifications in any of the following areas: Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC)
- Experience with Medicaid and Medicare billing audits
- Experience in medical review, auditing, utilization review, compliance or regulatory work.
Responsibilities
- Provide clinical expertise in conducting investigations and completing comprehensive clinical audits in an effort to combat fraud, waste, and abuse.
- Ensure billing compliance with OHCA policy, state statutes, and federal regulations.
- Performs analysis and evaluation of billed services including claims and documentation to ensure all HCA policy requirements are met and services are clinically/medically appropriate.
- Collaborate with others across the unit, organization, and external entities to evaluate audit results and make referrals to appropriate parties.
- Communicate audit findings to all stakeholders.
- Represents the Provider Audits Unit before an Administrative Law Judge (ALJ) and in legal proceedings regarding any general provider appeals, in an informed and professional manner.
- Maintain licensure and certifications.
- Other duties as assigned.
Benefits
- Generous state-paid benefit allowance to offset insurance premiums.
- A wide selection of insurance plans with no pre-existing condition exclusions.
- Flexible Spending Accounts for health care and dependent care.
- Retirement Savings Plan with employer contributions.
- 11 paid holidays annually.
- 15 days of vacation and 15 days of sick leave in the first year.
- Longevity Bonus recognizing years of public service.
- Public Service Loan Forgiveness eligibility and tuition reimbursement.
- Wellness benefits, including an on-site gym and fitness center discounts.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
