• Schedule and conduct premium audits with insured clients. • Collect and review required documentation in compliance with client requirements. • Prepare accurate audit reports according to company standards. • Communicate effectively with insureds and internal stakeholders. • Manage workload independently while meeting deadlines and quality standards.

Role Description The Clinical Auditor I performs detailed medical record audit review and analysis of the health plan’s outpatient, professional and ancillary claims to ensure that all reimbursement to the provider is paid accurately and ensuring adherence to regulations, internal policies and best practice of patient care. Qualifications - Bachelor's degree in nursing or an equivalent combination of education, training, and experience is required. - Two years CM, UM, claims auditing or other clinical health insurance role. - Two years minimum RN experience in acute care setting. - Behavioral Health and/or Inpatient DRG experience required. Requirements - Valid Registered Nurse License required. - Coding Certification Preferred - CPC or CCS certification. - Basic familiarity with CPT, ICD-10 and HCPCS coding is preferred. - Claims processing experience is preferred. Benefits - Full-time remote work. - Competitive salaries. - Excellent benefits. - Generous total compensation that includes benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Key Functions/Responsibilities - Analyze patient records, treatment plans, and medical billing documents to ensure accuracy, completeness, and strict compliance with healthcare standards and regulations. - Verify that procedures and diagnoses are accurately coded using appropriate CPT, HCPCS, and ICD-10 codes. - Check for consistent documentation across patient records, confirming that all entries adhere to regulatory mandates, internal policies, contract stipulations, and benefit coverages. - Identify any documentation or billing discrepancies during the review process. - Based on audit findings, regularly update and refine clinical audit guidelines and protocols. - Use statistical and analytical methods to examine clinical data. - Methodically review data to identify discrepancies and irregularities. - Analyze data trends to determine potential areas of risk. - Continuously monitor and document recurring patterns or anomalies in clinical data. - Provide well-founded recommendations for new audit projects. - Conduct both scheduled and ad hoc audits in strict accordance with established guidelines and internal processes. - Develop comprehensive audit reports that clearly outline all findings. - Play a supportive role in the amendment and appeals process. - Finalize all audits by ensuring that all findings are documented. - Collaborate closely with clinical staff, audit coordinator, and other members of the audit team. - Maintain active communication with providers by preparing precise documentation. - Ensure that any audit denial rationale is clearly communicated. - Continuously monitor evolving federal and state healthcare regulations. - Evaluate clinical and reimbursement activities to determine payment compliance. - Proactively identify potential fraud and abuse. - Refer cases to the Special Investigations Unit (SIU) or the Third-Party Liability team. - Detect potential quality of care or utilization issues during audits. - Assist in educating clinical personnel on documentation requirements and audit practices.

TITLE: Auditor Job Description: Location:Baltimore, MD / Hybrid / Rockville, MD Finance / Full Time Hybrid / Hybrid Auditor Employment Type: Full-Time, Mid-Level Department: Financial CGS is seeking a highly skilled Auditor to provide general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection. The ideal candidate will develop, coordinate, and draft technical audit guidelines, is proficient in a variety of accounting systems, and practices excellent cross-functional communication throughout investigations. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success: - Analyze and audit a variety of accounting systems. - Analyze, organize, and present a large volume of data such as bank records, financial records, healthcare claims, tax records, correspondence, policies, other documentary evidence, etc., through the use of common software programs. - Assist with the planning of investigations, including performing quantitative and qualitative analyses to identify potential witnesses and relevant financial documents. - Prepare concise and accurate reports of results of analysis, including detailed charts, summaries and schedules as necessary. - Assist with conferences and interviews of representatives of financial institutions, Certified Public Accountants, and other potential witnesses to financial activities. - Utilize electronic databases to identify assets, documents, and other physical evidence. - Analyze an individual or corporation’s ability to pay monetary penalties based on financial disclosures and independent investigation of assets and liabilities. - Perform ancillary investigation-related services in support of assigned cases as follows: - Develop, coordinate and issue draft technical audit guidelines and instructions applicable to financial audits and investigations. - Prepare interim and final reports throughout the investigation process for use by staff members. - Arrange for secure storage, preservation, organization and indexing of voluminous documentary evidence. - Assist in the compilation and analysis of documents and physical evidence, and the creation of charts, graphs, and other audio-visual materials for use in motions and at trial. - Meet with the designated federal agency personnel, state and local officials as needed throughout investigations. - Other related duties as assigned and within scope.x Qualifications: - Four-year undergraduate degree or higher in statistical/data analysis, finance, accounting, fraud examination, or other related field. - Minimum 3 years of professional work experience in finance, accounting, fraud examination or statistical/data analysis. - Proficient in Microsoft Office applications including Word, Excel, PowerPoint, Access, etc. - U.S. Citizenship and ability to obtain adjudication for the requisite background investigation. - Experience and expertise in performing the requisite services in Section 3 Preferred qualifications: - Experience reviewing and understanding medical records and knowledge of medical billing procedures, including experience using STARS and/or Business Objects. - Relevant experience working with a federal or state legal or law enforcement entity. Our Commitment: Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package. - Health, Dental, and Vision - Life Insurance - 401k - Flexible Spending Account (Health, Dependent Care, and Commuter) - Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board: https://cgsfederal.com/join-our-team/ #CJ $50,000 - $100,000 a year We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Title: Auditor Location: Chicago, IL / Hybrid / Detroit, MI Job Description: Finance / Full Time Hybrid / Hybrid Auditor Employment Type: Full-Time, Mid-Level Department: Financial CGS is seeking a highly skilled Auditor to provide general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection. The ideal candidate will develop, coordinate, and draft technical audit guidelines, is proficient in a variety of accounting systems, and practices excellent cross-functional communication throughout investigations. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success: - Analyze and audit a variety of accounting systems. - Analyze, organize, and present a large volume of data such as bank records, financial records, healthcare claims, tax records, correspondence, policies, other documentary evidence, etc., through the use of common software programs. - Assist with the planning of investigations, including performing quantitative and qualitative analyses to identify potential witnesses and relevant financial documents. - Prepare concise and accurate reports of results of analysis, including detailed charts, summaries and schedules as necessary. - Assist with conferences and interviews of representatives of financial institutions, Certified Public Accountants, and other potential witnesses to financial activities. - Utilize electronic databases to identify assets, documents, and other physical evidence. - Analyze an individual or corporation’s ability to pay monetary penalties based on financial disclosures and independent investigation of assets and liabilities. - Perform ancillary investigation-related services in support of assigned cases as follows: - Develop, coordinate and issue draft technical audit guidelines and instructions applicable to financial audits and investigations. - Prepare interim and final reports throughout the investigation process for use by staff members. - Arrange for secure storage, preservation, organization and indexing of voluminous documentary evidence. - Assist in the compilation and analysis of documents and physical evidence, and the creation of charts, graphs, and other audio-visual materials for use in motions and at trial. - Meet with the designated federal agency personnel, state and local officials as needed throughout investigations. - Other related duties as assigned and within scope.x Qualifications: - Four-year undergraduate degree or higher in statistical/data analysis, finance, accounting, fraud examination, or other related field. - Minimum 3 years of professional work experience in finance, accounting, fraud examination or statistical/data analysis. - Proficient in Microsoft Office applications including Word, Excel, PowerPoint, Access, etc. - U.S. Citizenship and ability to obtain adjudication for the requisite background investigation. - Experience and expertise in performing the requisite services in Section 3 Preferred qualifications: - Experience reviewing and understanding medical records and knowledge of medical billing procedures, including experience using STARS and/or Business Objects. - Relevant experience working with a federal or state legal or law enforcement entity. Our Commitment: Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package. - Health, Dental, and Vision - Life Insurance - 401k - Flexible Spending Account (Health, Dependent Care, and Commuter) - Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board: https://cgsfederal.com/join-our-team/ #CJ $50,000 - $100,000 a year We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.