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, Engagement, Customer Service, 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 Auditor to join our team! The Healthcare Auditor will work in support of the to support the Department of Veterans Affairs - Financial Audit of Invoices and Billing Practices under VA’s Medical Disability Examination (MDEs) Contracts. The person in this role will be successful by: detail oriented, capable of working independently, and able to complete objective evaluations of medical records and claims as it pertains to fraud, waste and abuse.In the first 90 days success means demonstrating the ability to conduct independent, standards-based invoice audits and document results in a detailed and accurate manner based on criteria.
Additionally, the healthcare auditor should demonstrate the ability to prepare audit documentation and actively participate and contribute to audit team post-audit reviews and planning sessions.
This position is contingent upon award.
Responsibilities
- Responsible for independent and objective evaluation of medical records and claims as it pertains to fraud, waste and abuse
- Complete proactive medical record reviews using knowledge of medical procedures, Medicare policies, coding guidelines, etc.
- Utilize coding conventions, detection of fraud schemes, evaluation of reimbursement practices, and application of pertinent laws, rules and regulations to identify fraudulent billing patterns in claims, documentation, authorization for services, etc.
- Maintain 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
- Prepare audit working paper documentation supporting fieldwork and conclusions in accordance with GAGAS standards
- Assist in preparing written summaries of audit fieldwork results and conclusions for inclusion in formal written audit reports
- Engage with customers, audited entities, and team members to gather requirements and validate results
- Perform root-cause analysis; and identify corrective and preventative actions and opportunities for improvement
- The Auditor works independently and as part of an auditing team, supporting comprehensive audits of contractors’ electronic medical records, other documentation, and invoices. The audits are of vendors who provide Medical Disability Exams in support of the Department of Veteran Affairs
Qualifications
- Registered nurse or other licensed medical professional, BS in Business Administration or Healthcare Administration, or 5 or more years of relevant experience in lieu of a degree
- 1-3 years healthcare auditing experience including clinical, coding or experience with both
- Experience auditing in accordance with professional standards and industry practices required
- Knowledge of government payor practices, guidelines and procedures; knowledge of CPT, ICD-9, ICD-10, and HCPCS coding required
- Healthcare auditing, regulatory compliance or similar combination of education and experience will be considered
- Excellent communication skills, both written and verbal and proficiency in MS Word, Excel and PowerPoint required
- Demonstrated ability to work independently and as a team required
- Comfortable managing multiple, variable tasks with limited supervision within targeted timelines and thriving in a demanding, quickly changing environment
- Must be eligible to obtain a Veterans Affairs Public Trust Clearance (NACI background investigation)
Desired
- CPC, CIA, CHC and / or RHIT Certifications (preferred)
- Healthcare auditing, regulatory compliance or similar combination of education and experience will be considered
CATHEXIS is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability EEO IS THE LAW. The Company invites any applicant and/or employee to review the Company’s written Affirmative Action Plan. This plan is available for inspection upon request by contacting info@cathexiscorp.com .
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 the Recruiting Department RecruitingTeam@cathexiscorp.com
