Healthcare Audit Manager

Location Type: Remote Employment Type: [Not specified] Salary: [Not specified]

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 Audit Manager to join our team! This role is an exciting opportunity to lead a team that supports the Department of Veterans Affairs in ensuring accurate billing and preventing fraud, waste, and abuse within the VA’s Medical Disability Examination (MDE) Contracts. The position offers a critical focus on leading audit operations, supervising healthcare auditors, and serving as a subject matter expert within a high-impact federal initiative.

Responsibilities

• Responsible for establishing the methods and practices for supervision and supervisory review of independent and objective evaluation and documentation of observations/findings based on reviews of medical records and claims as it pertains to fraud, waste and abuse.
• Complete proactive medical record reviews using knowledge of medical procedures, Medicare policies, coding guidelines, etc., when required.
• Utilize coding conventions, detection of fraud schemes, evaluation of reimbursement practices, and application of pertinent laws, rules and regulations to identify fraudulent billing patterns in claims, documentation, authorization for services, etc.
• Maintain 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.
• Ensuring that the coordination for preparation of and completion of audit working paper documentation supporting fieldwork and conclusions in accordance with GAGAS standards is completed on-time and without errors.
• Encourage active team engagement with and between team members to gather requirements and validate results.
• Prepare written summaries of audit fieldwork results and conclusions for inclusion in formal written audit reports.
• Perform root-cause analysis; and identify corrective and preventative actions and opportunities for improvement in support of ad hoc reports and Post-Audit Reform and Recovery Summaries.
• Assign audit team tasks as required or delegate to the Lead Healthcare Auditors.
• The Healthcare Audit Manager works independently as part of the Audit Leadership Team, supporting comprehensive audits of contractors’ electronic medical records, other documentation, and invoices. The audits are of vendors who provide Medical Disability Exams in support of the Department of Veteran Affairs.
• Perform other duties as assigned.

Requirements

• Must have an active Public Trust or the ability to obtain and maintain a Public Trust, which requires U.S. citizenship, a favorable background check (including criminal, credit, and employment history).
• Bachelor’s degree in Business Administration, Healthcare Administration, or a related field.
• Five (5) or more years of experience in healthcare auditing, including clinical or coding experience, with at least five (5) years of experience managing audit teams.

Company Information

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; and empower our employees to create innovative and trusted results.