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CoventBridge Group · 4 hours ago

Program Integrity Audit Supervisor

United States

Full-time

Remote

Mid, Senior Level

$65K/yr - $85K/yr

2+ years exp

CoventBridge Group is a company focused on improving healthcare delivery by identifying and eliminating fraud, waste, and abuse. The Program Integrity Audit Supervisor will conduct performance audits of Medicaid Managed Care Plans, issue findings and recommendations, and ensure compliance with audit standards.

Customer ServiceOutsourcing

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

Qualification

Medicaid program knowledgePerformance auditingAudit strategy designCertified Fraud ExaminerData analysis techniquesResearch skillsLeadership skillsTime managementWritten communicationVerbal communication

Required

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

Bachelor's Degree or equivalent related experience

Minimum of two (2) years of experience conducting healthcare 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