The Senior Provider Auditor conducts financial analysis and desk reviews to ensure accurate Medicare reimbursement for healthcare providers. They also provide mentorship, training, and strategic guidance to junior staff to ensure quality control and compliance.
The Supervisor Provider Audit leads and develops CMS provider audit and reimbursement staff to ensure contractual obligations and performance metrics are met. They prioritize workloads, coach team members, and serve as a subject matter expert for internal and external stakeholders.
The Program Integrity Director defines and leads the enterprise strategy for fraud, waste, and abuse prevention, payment integrity, and compliance operations. This role is responsible for developing multi-year strategies to enhance contract value, drive innovation, and improve operational performance for federal customers.
The Redeterminations Examiner reviews incoming Medicare appeals to ensure compliance with CMS regulations and established policies. They research claims processing deficiencies, initiate corrective responses, and maintain accurate documentation throughout the appeal process.
The Provider Auditor conducts financial analysis and desk reviews to ensure proper Medicare reimbursement for health care providers. They are responsible for identifying compliance issues, mentoring junior staff, and preparing detailed audit reports.
