Remote Medicaid Fraud Auditor — Audit & Compliance Expert

Peraton; Reston (VA); Remote; USD 90,000 - 130,000; Full time

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Medicaid Fraud Auditor to join our SGS team of professionals.

This role researches and interprets federal and state Medicaid requirements, develops audit procedures, analyzes claims, identifies overpayments, and communicates audit conclusions clearly. The position is remote and requires residence within the Northeast Jurisdiction. You will mentor junior staff and contribute at meetings to advance the program integrity mission.

Qualifications

• Bachelor's degree in a related field or equivalent experience.
• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD.
• Experience conducting Medicaid, Medicare, healthcare, compliance, financial, internal, or program integrity audits.
• Ability to independently plan, conduct, document, and complete audits or complex reviews.
• Ability to interpret laws, regulations, policies, and contractual requirements and apply to audit findings.
• Experience analyzing healthcare claims, billing records, or provider records.
• Identify noncompliance, improper payments, or overpayments.
• Strong written communication and audit reporting skills.
• Strong analytical, organizational, research, and problem-solving skills.
• Ability to work independently within policies and audit methodologies.
• Ability to manage multiple assignments and meet deadlines.

Responsibilities

• Conduct Medicaid compliance, payment, provider, and focused audits across provider types.
• Independently perform audit activities from planning to completion.
• Research federal and state statutes, regulations, and Medicaid manuals.
• Develop audit testing procedures addressing identified risks.
• Analyze claims, data, and records to identify noncompliance and improper payments.
• Determine potential Medicaid overpayments using audit methodologies.
• Maintain complete, accurate audit workpapers and case files.
• Conduct interviews and obtain information from providers and beneficiaries.
• Prepare audit reports and related written products.
• Support Lead and Manager; mentor new staff.
• Participate in meetings and training to enhance skills.

Skills

US Citizenship

Auditing

Research & interpret laws

Communication

Project management

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Education

Bachelor's degree in accounting, finance, business, healthcare administration, public health, health science, law, or related field

Equivalent combination of education and experience

MS/MA degree (preferred for some roles)

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Job description

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Medicaid Fraud Auditor to join our SGS team of professionals.

This role researches and interprets federal and state Medicaid requirements, develops audit procedures, analyzes claims, identifies overpayments, and communicates audit conclusions clearly. The position is remote and requires residence within the Northeast Jurisdiction. You will mentor junior staff and contribute at meetings to advance the program integrity mission.