Senior Healthcare Auditor

Job Summary

A company is looking for a Senior Healthcare Auditor to support the Department of Veterans Affairs in ensuring compliance with billing practices and reducing fraud, waste, and abuse.

Key Responsibilities

• Conduct independent evaluations of medical records and claims to identify fraud, waste, and abuse
• Perform proactive medical record reviews and apply relevant coding guidelines and regulations
• Prepare audit documentation and summaries for formal reports, and engage with team members for validation of results

Required Qualifications

• Active Public Trust or ability to obtain one, 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
• Knowledge of government payor practices and coding (CPT, ICD-9, ICD-10, HCPCS)
• Experience auditing by professional standards and industry best practices