Healthcare Auditor (req-167)

About Team CATHEXIS

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.

You worked hard to get to where you are. You strive to make every day better than the day before. So do we. 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.

Job Summary

We are looking for a dynamic Healthcare Auditor to join our team! This role offers a rewarding opportunity to conduct independent, standards-based audits supporting the Department of Veterans Affairs in preventing fraud, waste, and abuse. The position combines meaningful work with collaborative planning and audit team engagement across high-impact federal healthcare contracts.

Responsibilities

• 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
• Prepare audit working paper documentation supporting fieldwork and conclusions by GAGAS standards as assigned
• Engage with team members to gather requirements and validate results
• The Auditor works independently and as part of an auditing 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 Veterans Affairs
• Perform other duties as required

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 (BS/BA) with three (3) or more years of relevant experience, or Master’s degree (MS/MA) with no experience required, or Certified Physical Therapist (or similar licensed medical professional) with four (4) or more years of experience may qualify under a documented waiver process
• Experience auditing by professional standards and industry best practices required
• Knowledge of government payor practices, guidelines and procedures; knowledge of CPT, ICD-9, ICD-10, and HCPCS coding required
• Healthcare auditing, regulatory compliance, or a similar combination of education and experience will be considered
• Excellent communication skills, both written and verbal, and proficiency in MS Word, Excel, and PowerPoint required
• Demonstrated ability to work independently and as a team required
• Comfortable managing multiple, variable tasks with limited supervision within targeted timelines and thriving in a demanding, quickly changing environment

Desired Skills

• CPC, CIA, CHC, and/or RHIT Certifications