Job Summary
A company is looking for a Senior Healthcare Auditor to support the Department of Veterans Affairs in ensuring proper billing practices and reducing fraud, waste, and abuse.
Key Responsibilities:
- Evaluate and document findings from medical records and claims related to fraud, waste, and abuse
- Conduct proactive medical record reviews and apply knowledge of coding guidelines and Medicare policies
- Prepare audit documentation and assist in summarizing audit results for formal reports
Required Qualifications:
- Active Public Trust or ability to obtain it, requiring U.S. citizenship and a favorable background check
- RN or other licensed medical professional preferred, or five years of relevant experience with two to four years in healthcare auditing
- Seven years of relevant experience required if lacking healthcare auditing experience
- Experience with auditing by professional standards and knowledge of coding practices (CPT, ICD-9, ICD-10, HCPCS)
- Demonstrated ability to work independently and as part of a team in a fast-paced environment
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