Senior Medicare/Medicaid Audit & Investigation Supervisor

Qlarant; New Mexico; Presencial; USD 90.000 - 120.000; Jornada completa

Descripción de la vacante

Qlarant is a not-for-profit organization delivering health care and human services programs across the United States. This role oversees audits/investigations related to Medicare/Medicaid compliance and fraud, waste, and abuse investigations, guiding the team and coordinating with law enforcement and regulatory agencies.

The position requires 5–7 years of experience (8–11 preferred), a Bachelor's degree, and certification in fraud examination.

Formación

• Bachelor's Degree required.
• 5–7 years of experience required; 8–11 years preferred.
• Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification preferred.

Responsabilidades

• Reviews new audits/investigations and assigns to auditors/investigators; vets providers with appropriate agencies and law enforcement.
• Conducts file reviews to ensure audit plan adequacy and proper documentation in case tracking systems.
• Leads audit/investigation projects, develops strategy, and documents findings for management.
• Interacts with Data and Medical Review departments to present audits/investigations, overpayments, and questions for stakeholder meetings.
• Communicates with law enforcement and regulatory agencies and assists with presenting findings for further action.
• Manages team performance with regular feedback and formal performance reviews.

Conocimientos

Audit investigations

Team leadership

Stakeholder communication

Legal testimony

Project management

Educación

Bachelor's degree

Herramientas

Case management software

Descripción del empleo

Qlarant is a not-for-profit organization delivering health care and human services programs across the United States. This role oversees audits/investigations related to Medicare/Medicaid compliance and fraud, waste, and abuse investigations, guiding the team and coordinating with law enforcement and regulatory agencies.

The position requires 5–7 years of experience (8–11 preferred), a Bachelor's degree, and certification in fraud examination.