Commence · 14 hours ago
Medicaid Audit Team Lead
Indianapolis, IN
Full-time
Onsite
Senior Level
5+ years expCommence is at the forefront of data-centric transformation in healthcare, aiming to elevate health outcomes through efficient processes. They are seeking a Medicaid Audit Team Lead to manage comprehensive audits, ensuring compliance and effective recovery while leading a team and coordinating with state entities.
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Responsibilities
Lead audit team in conducting comprehensive provider and member audits
Develop audit plans, methodologies, and sampling strategies
Review and approve audit findings and overpayment calculations
Prepare audit recommendations for State review and approval
Coordinate with clinical staff on medical necessity determinations
Manage case progression from preliminary investigation through final disposition
Ensure audit documentation meets State and federal standards
Supervise audit analysts and provide training and mentorship
Interface with providers regarding audit findings and appeals
Track audit performance metrics and recovery rates
Participate in quarterly business planning and fraud trend analysis
Attend bi-weekly status meetings and provide audit updates to State
Qualification
Required
Bachelor's degree in Accounting, Finance, Healthcare Administration, or related field
Professional certifications required: CPA, CFE, CIA, or CHC
Minimum 5 years of healthcare audit experience, preferably in Medicaid program integrity
Minimum 3 years of supervisory or team lead experience
Proven track record of identifying and quantifying healthcare fraud and overpayments
Experience with medical record review and clinical documentation analysis
Demonstrated success managing complex multi-provider audits
Expert knowledge of audit methodologies and sampling techniques
Deep understanding of Medicaid billing rules and documentation requirements
Proficiency with medical coding systems (CPT, HCPCS, ICD-10)
Knowledge of fraud schemes and abuse patterns by provider type
Strong analytical and investigative skills
Excellent written and verbal communication abilities
Proficiency with data analytics tools and case management systems
Leadership and team development capabilities
Full-time dedication to Indiana contract
Available for in-person meetings at State offices as required
Successfully pass background check
Subject to State approval
Preferred
Multiple certifications preferred
Company
Commence
Commence delivers AI-driven healthcare data platform and clinical expertise that supports analytics, decisions, and workflow improvement.
501-1000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase