Alliance Health

Program Integrity Auditor

Alliance Health

full-time

Posted on:

Location Type: Hybrid

Location: Morrisville • North Carolina • United States

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Salary

💰 $33 - $42 per hour

About the role

  • Provide detailed analysis and identify improper payments.
  • Recommend corrective actions and mitigate risk through provider education and support.
  • Conduct routine and targeted post-payment audits of Medicaid and State funded providers.
  • Develop audit plans and tools based on the services to be audited.
  • Collect and document evidence.
  • Identify inappropriate billing and improper payments.
  • Document audit activities and findings in detailed reports.
  • Present audit results to leadership and Compliance Committee.
  • Conduct reviews of newly enrolled providers to ensure eligibility.

Requirements

  • Bachelor’s degree in health care compliance, analytics, government/public administration, auditing, security management, criminal justice, or pre-law
  • Three (3) years of post-degree of experience in healthcare compliance, regulatory analysis, policy development, auditing, investigations, accreditation or any equivalent combination of related training and experience.
  • Health care industry and/or Medicare/Medicaid/Behavioral Health knowledge
  • Certification from AHFI, CFE, CPMA, CPC, CHC, or equivalent
  • CLEAR Certified Investigator (Basic and Specialized)
  • Clinical license as an LCSW, LCMHC, LMFT, LCAS, or LPA
Benefits
  • Medical
  • Dental
  • Vision
  • Life
  • Long Term Disability
  • Generous retirement savings plan
  • Flexible work schedules including hybrid/remote options
  • Paid time off including vacation, sick leave, holiday, management leave
  • Dress flexibility
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
audit planspost-payment auditsbilling analysisrisk mitigationevidence collectionreport documentationprovider educationregulatory analysispolicy developmentinvestigations
Soft Skills
communicationleadershipanalytical thinkingattention to detailproblem-solving
Certifications
AHFICFECPMACPCCHCCLEAR Certified InvestigatorLCSWLCMHCLMFTLCAS