Audit Manager - Medicaid

We are looking to add an Audit Manager - Medicaid to our team of professionals as part of the Southeastern Unified Program Integrity Contract (SE UPIC).

The SE UPIC is responsible for audits/investigations in eight States and two Territories. The Audit Manager - Medicaid will focus on the actual operations of the Medicaid Managed Care Plan’s (MCP) and evaluate whether their activities are safeguarding the Medicaid program and providing appropriate services to beneficiaries. This includes comprehensive Managed Care Organizations (MCOs), as well as Pre-Paid Inpatient Health Plans (PIHPs) and Pre-Paid Ambulatory Health Plans (PAHPs). 

What you'll do:

This position entails providing direction to a staff of Auditors to identify and research issues of potential fraud, waste and abuse.  The Audit Manager will utilize available resources to evaluate MCP compliance efforts, such as proactive data analytics, utilization of cost-avoidance measures, and conducting audits/investigations, to ensure that the MCPs are taking the necessary steps to safeguard the Medicaid program. The Audit Manager will collaborate with other teams in the SE UPIC to analyze data, review paid Medicaid claims, issue finding reports, and assist in meeting workload expectations and quality objectives.  

• Establish goals, objectives and plans for the unit
• Motivate staff and evaluate performance
• Plan resources to address workload needs, set priorities and report unit activity
• Administer compensation and other corporate polices
• Recruit and develop staff
• Participate in internal/external quality audits
• Develop process efficiencies
• Effectively liaison with external stakeholders
• Telework available from contiguous United States

Basic Qualifications:

• 6 years of experience, may have lead experience. (Relevant experience skills could include: forensic accounting, accounting, audit/compliance, complex investigation, and management/supervisory experience in these related fields)
• This position requires proven leadership skills and in-depth knowledge of the Medicare/Medicaid Program to include laws, rules and regulations related to payment for services billed to the Programs.
• Excellent organizational and communications skills as well as strong PC skills.
• Ability to effectively work independently and as a member of a team
• Designing audit/investigative strategies for performing provider reviews
• Coordination of investigative activities with internal and external partners
• Experience leading teams in a fast-paced environment
• Ability to evaluate processes and find innovative solutions to improve efficiency.
• US citizenship is required.

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