Job Summary
A company is looking for a Lead Healthcare Auditor to support the Department of Veterans Affairs in ensuring compliance and reducing fraud in medical billing practices.
Key Responsibilities:
- Supervise and review evaluations of medical records and claims related to fraud, waste, and abuse
- Conduct proactive medical record reviews and apply coding conventions to identify fraudulent billing patterns
- Prepare audit documentation and summaries of findings in compliance with GAGAS standards
Required Qualifications:
- Active Public Trust or ability to obtain one, requiring U.S. citizenship and a favorable background check
- Registered nurse or licensed medical professional, or a Bachelor's Degree in a related field with relevant work experience
- Five plus years of healthcare auditing experience, including clinical and coding experience
- Knowledge of government payor practices and coding standards (CPT, ICD-9, ICD-10, HCPCS)
- Experience with auditing by professional standards and industry best practices
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