Job Description: Healthcare Analyst & Auditor

Salary: [Not Specified]

Location Type: Remote

Employment Type: Full-time

Position Overview

Team CATHEXIS elevates the government contracting experience through rapid response, deep skill, and thoughtful problem-solving and communication. Our core capabilities are our top-tier program and project management, data analytics, and audit services, the backbone of which is our integrated approach to operational excellence.

We are looking for a dynamic Healthcare Analyst & Auditor to join our team! The Healthcare Data Analyst & Auditor will be successful by being detail-oriented, demonstrating the ability to work independently, maintaining connectivity and access to the VA network and required systems, and completing objective evaluation, testing, or audits of invoice and claims data as it pertains to fraud, waste, and abuse. Demonstrating the ability to conduct independent, standards-based invoice audits, testing, and management of IDEA project files and document results based on criteria in a detailed and accurate manner with supervisory review. Additionally, the healthcare IDEA data analyst & auditor should demonstrate the ability to prepare assigned audit documentation and actively participate and contribute to audit team planning sessions and post-audit reviews.

Company Culture & Values

Team CATHEXIS operates with an all-in mindset. We are working together to create a company that supports our shared values and individual goals. Our values are centered around Respect, Integrity, Teamwork, and Excellence in everything we do for our employees, clients, partners, and communities. We believe success is best when we:

• Listen and lead with empathy.
• Model high standards of ethics to provide a rewarding candidate experience.
• Work hard, have fun, and appreciate the strengths we all bring to the team.
• Empower our employees to create innovative and trusted results.

Responsibilities

• Provide analytical and data sampling support to ongoing audits of medical invoices for compliance with specific coding, service, and billing practices.
• Responsible for independent and objective evaluation and documentation of observations/findings based on reviews of medical records and claims as they pertain to fraud, waste, and abuse as assigned.
• Complete medical record reviews using knowledge of medical procedures, Medicare policies, coding guidelines, etc., as assigned.
• Utilize coding conventions, detect fraud schemes, evaluate reimbursement practices, and apply pertinent laws, rules, and regulations to identify fraudulent billing patterns in claims, documentation, service authorization, etc.
• Maintain a 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.
• Completes comprehensive analytical review of all electronic invoices to ensure accuracy and completeness as assigned.
• Apply advanced analytical techniques to identify potential anomalies and irregularities as part of the audit team.
• Utilizes IDEA auditing software to develop auditing methods and tests and export those results for audit team analysis.
• Perform invoice testing and document processes and results using IDEA (audit software).
• Collaborate with the Audit Team to support audit research and root cause analysis.

Requirements

• Bachelor's Degree: A bachelor's degree (in lieu of a bachelor's degree, an additional 4 years of relevant work experience) in a relevant field such as Accounting, Finance, Healthcare Administration, or a related area is typically required. This foundational education provides the necessary background in principles of accounting, auditing, and healthcare systems.
• Relevant Experience: A minimum amount of professional experience in auditing, financial analysis, or healthcare administration is usually required.