Healthcare Analyst & Auditor (req-150)

Team CATHEXIS elevates the government contracting experience through rapid response, deep skill, and thoughtful problem-solving and communication. Our core capabilities are our top-tier program and project management, data analytics, and audit services, the backbone of which is our integrated approach to operational excellence.You worked hard to get to where you are. You strive to make every day better than the day before. So do we. Team CATHEXIS operates with an all-in mindset. We are working together to create a company that supports our shared values and individual goals. Our values are centered around Respect, Integrity, Teamwork, and Excellence in everything we do for our employees, clients, partners, and communities. We believe success is best when we listen and lead with empathy; model high standards of ethics to provide a rewarding candidate experience; work hard, have fun, and appreciate the strengths we all bring to the team; and empower our employees to create innovative and trusted results.We are looking for a dynamic Healthcare Analyst & Auditor to ! The Healthcare Data Analyst & Auditor will be successful by being detail-oriented, demonstrating the ability to work independently, maintaining connectivity and access to the VA network and required systems, and completing objective evaluation, testing, or audits of invoice and claims data as it pertains to fraud, waste, and abuse. Demonstrating the ability to conduct independent, standards-based invoice audits, testing, and management of IDEA project files and document results based on criteria in a detailed and accurate manner with supervisory review. Additionally, the healthcare IDEA data analyst & auditor should demonstrate the ability to prepare assigned audit documentation and actively participate and contribute to audit team planning sessions and post-audit reviews. Responsibilities: Provide analytical and data sampling support to ongoing audits of medical invoices for compliance with specific coding, service, and billing practices Responsible for independent and objective evaluation and documentation of observations/findings based on reviews of medical records and claims as they pertain to fraud, waste, and abuse as assigned Complete medical record reviews using knowledge of medical procedures, Medicare policies, coding guidelines, etc., as assigned Utilize coding conventions, detect fraud schemes, evaluate reimbursement practices, and apply pertinent laws, rules, and regulations to identify fraudulent billing patterns in claims, documentation, service authorization, etc. Maintain a thorough understanding of applicable laws, rules, regulations, coding and billing standards, VA policies and contractual provisions, and related requirements necessary to perform criteria-based audits Completes comprehensive analytical review of all electronic invoices to ensure accuracy and completeness as assigned Apply advanced analytical techniques to identify potential anomalies and irregularities as part of the audit team Utilizes IDEA auditing software to develop auditing methods and tests and export those results for audit team analysis Perform invoice testing and document processes and results using IDEA (audit software) Collaborate with the Audit Team to support audit research and root cause analysis Requirements: Bachelor's Degree: A bachelor's degree (in lieu of a bachelor's degree, an additional 4 years of relevant work experience) in a relevant field such as Accounting, Finance, Healthcare Administration, or a related area is typically required. This foundational education provides the necessary background in principles of accounting, auditing, and healthcare systems Relevant Experience: A minimum amount of professional experience in auditing, financial analysis, or healthcare administration is usually required. The specific years of experience can vary but might range from 2 to 5 years for a mid-level position. This experience should include hands-on work in auditing processes, financial reporting, and compliance with healthcare regulations Knowledge of Healthcare Regulations: Understanding relevant healthcare regulations and standards, such as HIPAA, ACA, and CMS guidelines, is crucial for ensuring compliance in audit practices Must obtain and maintain a Public Trust Clearance Must be eligible to receive a Personal Identity Verification (PIV) card Desired Skills: Certifications: Professional certifications such as Certified Public Accountant (CPA), Certified Internal Auditor (CIA), or Certified Information Systems Auditor (CISA) are highly desirable. A Certified Healthcare Auditor (CHA) or Certified Fraud Examiner (CFE) certification can stand out for healthcare-specific credentials Specialized Healthcare Experience: Prior experience specifically within the healthcare industry, such as working in hospital administration, health insurance auditing, or public health organizations, is often preferred. This experience can provide a nuanced understanding of the challenges and complexities unique to healthcare CATHEXIS offers competitive compensation packages to all eligible employees. Our goal is to provide a compensation package that reflects the value you bring to our team, is competitive with market rates, and promotes your financial security and personal well-being. The annual salary range for this role is $60,000 - $75,000. Please note that the salary information provided is a general guideline. CATHEXIS considers various factors in its final offer, including location, qualifications, experience, and skills. Benefits: Performance Bonuses Medical Insurance Dental Insurance Vision Insurance 401(k) Plan (Traditional and ROTH) Life Insurance (Basic, Voluntary & AD&D) Paid Time Off 11 Federal Holidays Parental Leave Commuter Benefits Short Term & Long Term Disability Training & Development Wellness Program Community Outreach Initiatives CATHEXIS is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact RecruitingTeam@cathexiscorp.com. Apply tot his job Apply tot his job Apply To this Job