Lead Healthcare Auditor

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