Healthcare Auditor

United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Government Contracting, HealthcareIndustries

Requirements

Must possess an active Public Trust clearance or be able to obtain one, which requires U.S. citizenship and a favorable background check. A Bachelor's degree with three or more years of relevant experience, or a Master's degree with no experience, or a licensed medical professional with four or more years of experience may qualify. Experience with professional auditing standards and industry best practices is required, along with knowledge of government payor practices, guidelines, and procedures, including CPT, ICD-9, ICD-10, and HCPCS coding. Excellent written and verbal communication skills, proficiency in MS Office Suite, and the ability to work independently and as part of a team are essential. The candidate must be comfortable managing multiple tasks within targeted timelines in a demanding, fast-paced environment. Desired skills include CPC, CIA, CHC, and/or RHIT certifications.

Responsibilities

Conduct independent and objective evaluations and documentation of observations and findings based on reviews of medical records and claims related to fraud, waste, and abuse. Complete medical record reviews using knowledge of medical procedures, Medicare policies, and coding guidelines. Utilize coding conventions, detect fraud schemes, evaluate reimbursement practices, and apply pertinent laws, rules, and regulations to identify fraudulent billing patterns. Maintain a thorough understanding of applicable laws, rules, regulations, coding and billing standards, VA policies, and contractual provisions. Prepare audit working paper documentation supporting fieldwork and conclusions according to GAGAS standards. Engage with team members to gather requirements and validate results. Perform other duties as required.

Skills

Healthcare Auditing

Medical Records Review

Claims Analysis

Medicare Policies

Coding Guidelines

Fraud Detection

Waste and Abuse Prevention

Data Analytics

Program Management

Project Management

CATHEXIS

Government contracting services and project management

About CATHEXIS

Cathexis Corp enhances the government contracting experience by providing services that include program and project management, data analytics, and audit services. Their approach focuses on rapid response and employing highly skilled personnel to solve complex problems for government leaders. Cathexis tailors its offerings to meet the specific needs of its clients, ensuring that projects are completed efficiently and within budget. Unlike many competitors, Cathexis emphasizes flexibility in problem-solving and has been recognized for its commitment to service excellence, being named a finalist for the 2022 Veteran Owned Business of the Year. The company's goal is to help government entities achieve their mission objectives effectively.

Falls Church, VirginiaHeadquarters

2006Year Founded

VENTURE_UNKNOWNCompany Stage

Consulting, Government & Public SectorIndustries

51-200Employees