Medicaid FWA Auditor & Data Analyst (Remote)

ForHealth Consulting at UMass Chan Medical School; Westborough (MA); Hybrid; USD 70,000 - 90,000; Full time

Job summary

ForHealth Consulting at UMass Chan Medical School seeks an Auditor to identify, investigate, and prevent Medicaid fraud, waste and abuse. You will conduct desk and onsite audits across provider types, using data mining and claims analysis to detect irregular billing.

The role requires travel within Massachusetts for onsite audits 1-2 times per month; most work is remote with periodic site visits.

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• 4-6 years in healthcare; data mining in healthcare insurance; claims analysis.
• Knowledge of CPT, HCPCS and ICD-10 coding and claims policies.
• Strong analytical and problem-solving skills with root-cause focus.
• Ability to interpret regulations; travel within Massachusetts for audits.
• Proficiency in Word, Excel, PowerPoint, Access.
• Excellent customer service and stakeholder interaction.

Responsibilities

• Conduct desk and onsite audits to ensure compliance.
• Perform data mining and claims analysis to detect fraud.
• Prepare audit documentation and case files.
• Communicate findings and recovery process with providers.
• Recommend policy and system changes.
• Update internal staff on investigation progress.
• Stay current with regulatory updates.
• Assist with document management and record retention.
• Perform other duties as assigned.

Skills

Data mining

Auditing

Analytical skills

Microsoft Office

Communication with providers

Education

Bachelor's degree or equivalent combination of education and experience

Tools

Microsoft Office (Word, Excel, PowerPoint, Access)

Job description

ForHealth Consulting at UMass Chan Medical School seeks an Auditor to identify, investigate, and prevent Medicaid fraud, waste and abuse. You will conduct desk and onsite audits across provider types, using data mining and claims analysis to detect irregular billing.

The role requires travel within Massachusetts for onsite audits 1-2 times per month; most work is remote with periodic site visits.