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Healthcare Facility Compliance Auditor

2 months ago

Richmond, Virginia, United States Commonwealth of Virginia Full time
Healthcare Facility Compliance Auditor at Commonwealth of Virginia

The Commonwealth of Virginia is pleased to present an exceptional opportunity for a Healthcare Facility Compliance Auditor within the Program Integrity Division.

  • Conduct thorough compliance assessments of Medicaid services to ensure adherence to Federal and State regulations and policies.
  • Examine medical documentation to confirm reimbursement eligibility and compliance with established regulations.
  • Detect and report on fraudulent billing practices and potential instances of fraud, waste, and abuse.
  • Manage referrals and complaints, including those directed to the Medicaid Fraud Control Unit.
  • Engage in the development of policies and procedures while providing training to healthcare providers and staff.

Essential Qualifications

  • In-depth knowledge of Medicaid programs and strategies for fraud prevention.
  • Experience in medical auditing and utilization review specific to Medicaid.
  • Proficient in data analysis, problem-solving, and report generation.
  • Skilled in interpreting State and Federal regulations while adhering to deadlines.
  • Experience collaborating with both internal and external stakeholders.

Additional Information

This role necessitates a fingerprint-based Criminal History Background Check and other verifications. Applications must be submitted electronically. The Commonwealth of Virginia is committed to equal employment opportunities without discrimination based on various factors.

Contact Information

Name: Commonwealth of Virginia Talent Acquisition