Program Integrity Auditor
$46,988–$122,400 year
Remote · Arizona, United States
Job Summary
Audits provider records to ensure correct coding and documentation across Medicaid and health-plan operations; identifies aberrant billing patterns and potential FWA; coordinates documentation and reports for internal/external stakeholders; provides provider education on regulatory requirements and coding standards; supports regulator deliverables and prospective/retrospective FWA avoidance strategies; requires an Associate’s degree (or equivalent) and 3-5 years of claims-data/medical-record review experience with CPT/HCPCS/ICD-10; full-time, Arizona-time hours, work-from-home in the Arizona US time zone.
Required Qualifications
- 3-5 years of experience in reviewing and interpreting claims data, as well as medical records and appropriate documentation
- 3-5 years of experience with standard industry coding guidelines such as CPT, HCPCS, and ICD-10
- active CPC (Certified Professional C coder), CCS (Certified Coding Specialist), or CPMA (Certified Professional Medical Auditor) license
- Education: Associate’s degree or equivalent experience (2+ years of relevant experience + high school diploma or GED)
- Willingness to work Monday-Friday from 8am-5pm Arizona Time Zone
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