Healthcare Compliance Auditor

2 weeks ago


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

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

  • Conduct thorough evaluations 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 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 both providers and staff.

Essential Qualifications

  • Comprehensive understanding of Medicaid programs and fraud prevention strategies.
  • Proven experience in medical auditing and utilization review for Medicaid initiatives.
  • Expertise in data analysis, problem resolution, and report generation.
  • Ability to interpret State and Federal regulations effectively 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 necessary verifications. All applications and resumes 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



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