Medicaid Audit and Compliance Specialist UPIC SE (Full-time, Remote)

Medicaid Audit and Compliance Specialist conducts Medicaid/Managed Care Plan audits to identify fraud, waste, and abuse, issues findings and recommendations, and ensures programs adhere to federal/state regulations. Responsibilities include desk and onsite audits, licensing/exclusion reviews, preparing medical record requests, applying GA/GAS standards, data mining to detect anomalies in Medicaid billing, preparing objective audit reports for leadership and government partners, and collaborating with federal/state agencies. Requires strong data analysis, knowledge of ICD-9-CM/ICD-10-CM/HCPCS/CPT codes, and experience auditing government payment programs; proficient in Microsoft Office; ability to work independently and in a team; and ability to manage multiple priorities while meeting deadlines.