Bringing our heart to every moment of your health.
Program Integrity Auditor
Location
Arizona
Posted
22 days ago
Salary
$47.0K - $122.4K / year
Seniority
Senior
Job Description
Program Integrity Auditor
CVS Health
• Serve as an audit team member for a health plan(s) which currently administers benefits to Medicaid members across multiple lines of business including acute, behavioral health, individuals with developmental disabilities, and children in out-of-home care. • Audit records on a routine basis, as well as records for audits (requested on an ad hoc basis) for all lines of business, in order to ensure coding and documentation meet regulatory standards. • Coordinate audit documentation and reports for review for internal and external staff and stakeholders. • Identify aberrant billing patterns and potential FWA, reporting this to internal staff. • Assisting with further investigation and/or reports to state regulators through the utilization of developed critical thinking skills. • Assist with the development and implementation plan for prospective and retrospective FWA avoidance, detection, and referral. • Assist with the creation and submission of regulator deliverables through completion of timely audit activities. • Provide technical assistance and education to providers including training on regulatory requirements, as well as coding and documentation rules. • Maintain compliance with company policies and procedures. • Perform other duties as assigned.
Job Requirements
- 3-5 years of experience in reviewing and interpreting claims data, as well as medical records and appropriate documentation.
- 3-5 years of experience with standard industry coding guidelines such as CPT, HCPCs, and ICD-10.
- Willingness to work Monday-Friday from 8am-5pm Arizona Time Zone.
- Must possess an active CPC ( Certified Professional Coder ), CCS ( Certified Coding Specialist ), or CPMA ( Certified Professional Medical Auditor ) license.
- Previous auditing experience.
- Previous Medicaid and/or health plan experience, including AHCCCS ( Arizona Health Care Cost Containment System ).
- Previous experience with QuickBase.
- Strong analytical and critical thinking skills.
- Strong attention to detail.
- Ability to collaborate and work with a team, as well as work independently as needed.
- Excellent presentational and strong communication skills, both written and verbal.
- Ability to be adaptable in a flexible environment.
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs and other resources
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