Senior Medical Audit Specialist

Oklahoma Ag; Oklahoma City, Northern (OK, KY); Hybrid; USD 78,000 - 81,000; Full time

Benefits offered by this job

State-paid benefits

Flexible Spending Accounts

Retirement Savings Plan

11 paid holidays

15 days of vacation

15 days of sick leave

Public Service Loan Forgiveness/tuion

Job summary

The Oklahoma Health Care Authority (OHCA) seeks a Senior Medical Audit Specialist to safeguard healthcare integrity through clinical audits and investigations. You will ensure billing compliance with OHCA policies and federal regulations, analyzing claims to confirm medical necessity and appropriate documentation.

Key responsibilities include collaboration with multiple stakeholders, presenting audit findings, and representing OHCA in formal proceedings when required.

Qualifications

• In-depth knowledge of healthcare policies and regulations governing audits.
• Ability to analyze complex billing data to ensure compliance.
• Preference for certifications in medical auditing or coding.
• Strong communication and collaboration across stakeholders.
• Experience with Medicaid/Medicare billing audits is a plus.

Responsibilities

• Provide clinical expertise in investigations and comprehensive audits to combat fraud, waste, and abuse.
• Ensure billing compliance with OHCA policy, state statutes, and federal regulations.
• Analyze billed services and documentation to verify policy and medical appropriateness.
• Collaborate with internal/external stakeholders to evaluate audit results and referrals.
• Communicate audit findings to stakeholders and participate in legal proceedings as needed.
• Maintain licensure/certifications and uphold professional standards.

Skills

Healthcare policy

Regulatory compliance

Audit processes

Billing data analysis

Communication

Collaboration

Education

RN license (Oklahoma)

Job description

## Senior Medical Audit SpecialistApply: Oklahoma County: Full time: Posted Today: End Date: October 22, 2026 (15 days left to apply): JR66317**Job Posting Title**Senior Medical Audit Specialist**Agency**807 HEALTH CARE AUTHORITY**Supervisory Organization**Program Integrity & Account**Job Posting End Date**Refer to the date listed at the top of this posting, if available. Continuous if date is blank.Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.**Estimated Appointment End Date (Continuous if Blank)****Full/Part-Time**Full time**Job Type**Regular**Compensation**$78,465.00/annual**Why You’ll Love Working Here**At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, **Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership**, we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.**Let’s Talk Benefits**We know your great work deserves great support. Here’s a snapshot of what we offer for all eligible employees.* Generous state-paid benefit allowance to offset insurance premiums.* A wide selection of insurance plans with no pre-existing condition exclusions.* Flexible Spending Accounts for health care and dependent care.* Retirement Savings Plan with employer contributions.* 11 paid holidays annually.* 15 days of vacation and 15 days of sick leave in the first year.* Longevity Bonus recognizing years of public service.* Public Service Loan Forgiveness eligibility and tuition reimbursement.* Wellness benefits, including an on-site gym and fitness center discounts.**Job Description****Location:** 4345 N Lincoln Blvd, Oklahoma City, OK 73105**Salary:** $78,465.00/annual**Work Schedule:** Monday – Friday**Primary Hours:** 8:00 a.m. – 5:00 p.m.Agency/Division InformationThe Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.Position PurposeThe Senior Medical Audit Specialist plays a critical role in safeguarding the integrity of healthcare services by providing clinical expertise in conducting audits and investigations to combat fraud, waste, and abuse. This position ensures compliance with OHCA policies, state statutes, and federal regulations through detailed analysis of billed services and documentation. By collaborating with internal and external stakeholders, the Senior Medical Audit Specialist helps to promote accountability and transparency in billing practices, supporting the overall mission of the Oklahoma Health Care Authority to provide better health and care for Oklahomans.Essential Functions May Include:* Provide clinical expertise in conducting investigations and completing comprehensive clinical audits in an effort to combat fraud, waste, and abuse.* Ensure billing compliance with OHCA policy, state statutes, and federal regulations.* Performs analysis and evaluation of billed services including claims and documentation to ensure all HCA policy requirements are met and services are clinically/medically appropriate.* Collaborate with others across the unit, organization, and external entities to evaluate audit results and make referrals to appropriate parties.* Communicate audit findings to all stakeholders.* Represents the Provider Audits Unit before an Administrative Law Judge (ALJ) and in legal proceedings regarding any general provider appeals, in an informed and professional manner.* Maintain licensure and certifications.* Other duties as assigned.**Supervisory Responsibilities:**This position does not supervise.Knowledge, Skills, Abilities and Competency RequirementsThe Senior Medical Audit Specialist requires in-depth knowledge of healthcare policies, state and federal regulations, and audit processes, as well as the ability to analyze complex billing data and ensure compliance. Strong communication and collaboration skills are essential to effectively convey audit findings and work with various stakeholders. This role demands strategic problem-solving and organizational skills to manage multiple tasks and resolve complex issues.The best-fitting Korn Ferry competencies for this position include Ensures Accountability, as the role focuses on enforcing compliance and managing responsibilities, and Collaborates, given the need for cross-functional teamwork and stakeholder engagement.**\\*\\*To be considered for this position your application must include a resume/CV with complete work and education history.\\*\\***Education and/or Experience:* Possession of a valid permanent Oklahoma license as a Registered Nurse (RN) as approved by the Oklahoma Board of Nursing or Registered Nurse License recognized by the Enhanced Nurse Licensure Compact (eNLC) AND* 5 years of professional experience as a registered nurse.* There is no substitution for licensure.Preference Qualifications Include:* Certifications in any of the following areas: Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC)* General understanding of coding principles (CPT, HCPCS, ICD-10 and /or DRG)* Experience with Medicaid and Medicare billing audits* Experience in medical review, auditing, utilization review, compliance or regulatory work.Physical Demands and Work EnvironmentWork is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.Accommodation StatementThe Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.