Medicaid FWA Auditor & Data Analyst

University of Massachusetts Medical School; Westborough (MA); Hybrid; USD 70,000 - 100,000; Full time

Job summary

University of Massachusetts Medical School seeks a Fraud, Waste, and Abuse Auditor to identify, investigate, and prevent fraudulent activity in Medicaid programs. You will conduct data mining, claims analysis, and medical record reviews, perform onsite audits, and prepare detailed audit documentation.

The role requires up-to-date knowledge of CPT/HCPCS/ ICD-10 coding, strong analytical skills, and the ability to travel within Massachusetts for audits; most work is remote with periodic onsite

Qualifications

• Bachelor's degree in business, healthcare administration, or related field or equivalent experience.
• 4-6 years in healthcare, with at least two years in data mining, audits or claims analysis.
• Knowledge of CPT/HCPCS/ ICD-10 coding and billing policies.
• Strong analytical and problem solving skills with ability to identify root causes.

Responsibilities

• Conduct data mining and claims analysis to detect fraudulent, wasteful or non-compliant billing.
• Perform desk and onsite audits to assess records and regulatory compliance.
• Prepare audit documentation, findings, and case files; calculate sanctions and overpayments.
• Communicate audit findings with providers and support recovery processes.
• Stay current with regulations, coding changes, and industry standards.
• Assist with case management and record retention procedures.

Skills

Data mining

Analytical thinking

Regulatory interpretation

Communication

Problem solving

Multi-tasking

Education

Bachelor's degree in business or healthcare administration

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Access

Job description

University of Massachusetts Medical School seeks a Fraud, Waste, and Abuse Auditor to identify, investigate, and prevent fraudulent activity in Medicaid programs. You will conduct data mining, claims analysis, and medical record reviews, perform onsite audits, and prepare detailed audit documentation.

The role requires up-to-date knowledge of CPT/HCPCS/ ICD-10 coding, strong analytical skills, and the ability to travel within Massachusetts for audits; most work is remote with periodic onsite