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Senior Healthcare Auditor

4 months ago

Washington, United States Cathexis Full time

Team CATHEXIS elevates the government contracting experience through rapid response, deep skill, and thoughtful problem-solving and communication based on customer requirements. Our core capabilities are our top-tier program and project management, learning solutions, performance improvement and business process redesign, data analytics and visualization, and audit services - each delivered through an integrated approach to operational excellence focusing on customer defined value.

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, Engagement, Customer Service, 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.

We are looking for a dynamic Senior Healthcare Auditor to join our team The Senior Healthcare Auditor will work to support the Department of Veterans Affairs - Financial Audit of Invoices and Billing Practices under VA's Medical Disability Examination (MDEs) Contracts. This is a remote position.

The person in this role will be successful by: being detail oriented, demonstrating the ability to work independently, maintaining connectivity and access to the VA network and required systems, maintaining access to the MDE Vendor portals, and completing objective evaluations of medical records and claims as it pertains to fraud, waste and abuse.

In the first 90 days success means demonstrating the ability to conduct independent, standards-based invoice audits and document results in a detailed and accurate manner based on criteria with supervisory review. Additionally, the healthcare auditor should demonstrate the ability to prepare assigned audit documentation and actively participate and contribute to audit team planning sessions and post-audit reviews.

Responsibilities:

  • Responsible for 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.
  • 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
  • Prepare audit working paper documentation supporting fieldwork and conclusions in accordance with GAGAS standards as assigned
  • Engage with team members to gather requirements and validate results
  • Assist in preparing written summaries of audit fieldwork results and conclusions for inclusion in formal written audit reports as assigned
  • Perform root-cause analysis; and identify corrective and preventative actions and opportunities for improvement
  • 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 Veteran Affairs
Skills:
  • Must have two to four (2-4) years healthcare auditing experience including clinical, coding or experience with both
  • Registered nurse or other licensed medical professional, BS in Business Administration or Healthcare Administration, or five (5) or more years of relevant experience in lieu of a degree
  • Experience auditing in accordance with 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 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
  • Must be eligible to obtain a Veterans Affairs Public Trust Clearance (NACI background investigation)
Desired Skills:
  • CPC, CIA, CHC and / or RHIT Certifications (preferred)
  • Healthcare auditing, regulatory compliance or similar combination of education and experience will be considered
Benefits:
  • Performance Bonuses
  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Plan (Traditional and ROTH)
  • Life Insurance (Basic, Voluntary & AD&D)
  • Paid Time Off
  • 11 Federal Holidays
  • Parental Leave
  • Commute Benefits
  • Short Term & Long Term Disability
  • Training & Development
  • Wellness Program
  • Community Outreach Initiatives


CATHEXIS is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact the RecruitingTeam@cathexiscorp.com.