Hybrid Healthcare Program Integrity Auditor

Alliance; United States; Hybrid; USD 95,899,000 - 122,239,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Life, LTD

Retirement savings plan

Hybrid/remote options

PTO including vacation, sick leave, &H

Dress flexibility

Job summary

Alliance Health in Morrisville, NC hybrid full-time Program Integrity Auditor role conducts post-payment and prepayment audits of Medicaid providers to ensure compliance with state and federal regulations. The position requires reporting findings and contributing to corrective actions.

This role calls for a Bachelor’s degree in health care compliance or related field with at least 3 years of healthcare compliance experience, plus willingness to travel across Alliance catchment areas to meet

Qualifications

• Bachelor’s degree in health care compliance or relevant field and 3 years of post-degree healthcare compliance experience.
• Experience with Medicaid/Medicare regulations, policy development, auditing or investigations.
• Ability to analyze complex data and document findings clearly.

Responsibilities

• Audit post-payment and prepayment reviews of Medicaid and state-funded providers.
• Develop audit plans and collect evidence and documents from providers.
• Identify improper payments and communicate findings to leadership.
• Prepare detailed audit reports and present results to Compliance Committee.
• Attend provider appeal hearings and participate in court hearings as needed.
• Travel to meet with members and providers across Alliance catchment area.

Skills

Compliance knowledge

Data analytics

Auditing

Policy development

Investigations

Regulatory analysis

Prior authorization

Utilization reviews

Provider credentialing

Education

Analytics

Auditing

Criminal Justice

Public Administration

Pre-Law

Job description

Alliance Health in Morrisville, NC hybrid full-time Program Integrity Auditor role conducts post-payment and prepayment audits of Medicaid providers to ensure compliance with state and federal regulations. The position requires reporting findings and contributing to corrective actions.

This role calls for a Bachelor’s degree in health care compliance or related field with at least 3 years of healthcare compliance experience, plus willingness to travel across Alliance catchment areas to meet