Senior Clinical Audit & Compliance Specialist

State of Oklahoma; Oklahoma; Sur place; USD 67 000 - 90 000; Plein temps

Résumé du poste

State of Oklahoma, Oklahoma Health Care Authority, is seeking a Senior Medical Audit Specialist to provide clinical expertise in audits, investigations, and compliance with state and federal regulations. The role focuses on safeguarding billing integrity and working with internal and external stakeholders to ensure accurate reimbursement.

The position requires an active RN license with 5+ years of nursing experience, and preferred certifications in medical auditing.

Qualifications

• RN licensure is required with no substitutions for licensure.
• 5+ years of professional nursing experience required.
• Certifications in medical auditing (CPMA/CPC) preferred.
• Experience with Medicaid/Medicare billing audits and medical reviews is a plus.

Responsabilités

• Provide clinical expertise in investigations and audits to detect fraud, waste, and abuse.
• Ensure billing compliance with OHCA policy, state statutes, and federal regulations.
• Analyze billed services and documentation to verify alignment with policy and clinical appropriateness.
• Communicate audit findings to stakeholders and participate in relevant hearings or proceedings.

Connaissances

Clinical expertise

Billing analysis

Communication skills

Collaboration

Formation

RN licensure (RN)

5+ years nursing experience

Description du poste

State of Oklahoma, Oklahoma Health Care Authority, is seeking a Senior Medical Audit Specialist to provide clinical expertise in audits, investigations, and compliance with state and federal regulations. The role focuses on safeguarding billing integrity and working with internal and external stakeholders to ensure accurate reimbursement.

The position requires an active RN license with 5+ years of nursing experience, and preferred certifications in medical auditing.