Junior Healthcare Auditor (req-)

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 Junior Healthcare Auditor to join our team! The Junior Healthcare Auditor will work to support the Department of Veterans Affairs - Financial Audit of Invoices and Billing Practices under VA's Medical Disability Examination (MDEs) Contracts, specifically travel-related invoices. This is aremote position.

The Junior Healthcare Auditor will be successful by: being detail-oriented, demonstrating the ability to work independently with supervisory review, maintaining connectivity and access to the VA network and required systems, maintaining access to the MDE Vendor portals, and completing objective evaluations of medical records and claims as they pertain to fraud, waste, and abuse with supervision.

Within the first 90 days, success entails demonstrating the ability to conduct independent, standards-based invoice audits and document the results in a detailed and accurate manner, based on established criteria, with regular supervisory review. Additionally, the Junior Healthcare Auditor should demonstrate the ability to prepare assigned audit documentation and actively participate and contribute to audit team planning sessions and post-audit reviews.

• Independently evaluates and documents observations and findings based on reviews of travel records and medical claims as they pertain to fraud, waste, and abuse with supervision
• Completes medical record reviews using knowledge of medical procedures (e.g., Medicare policies, coding guidelines, etc.) as assigned
• Utilizes 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
• Develops and maintains a thorough understanding of applicable laws, rules, regulations, coding and billing standards, VA policies and contractual provisions, and related requirements to perform criteria-based audits
• Prepares audit working paper documentation supporting fieldwork and conclusions in accordance with GAGAS standards as assigned
• Engages with team members to gather requirements and validate results
• Works independently and as part of an auditing team, supporting comprehensive audits of contractors' electronic medical records, other documentation, and invoices

• Must be eligible to obtain a Veterans Affairs Public Trust Clearance (NACI background investigation)
• 1 year relevant clinical or healthcare auditing experience, including clinical documentation and coding
• Healthcare auditing, regulatory compliance or a similar combination of education and experience will be considered
• Excellent communication skills, both written and verbal, and proficiency in MS Word, Excel, and PowerPoint are required.
• Comfortable managing multiple, variable tasks with limited supervision within targeted timelines and thriving in a demanding, quickly changing environment

• Experience in auditing in accordance with professional standards and industry best practices
• Knowledge of government payor practices, guidelines and procedures; knowledge of CPT, ICD-9, ICD-10, and HCPCS coding required
• Healthcare auditing, regulatory compliance, or a similar combination of education and experience will be considered

CATHEXIS offers competitive compensation packages to all eligible employees. Our goal is to provide a compensation package that reflects the value you bring to our team, is competitive with market rates, and promotes your financial security and personal well-being. The annual salary range for this role is $50,000 - $65,000. Please note that the salary information provided is a general guideline. CATHEXIS considers various factors in its final offer, including location, qualifications, experience, and skills.

CATHEXIS is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. 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@cathexiscorp.com.

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 Junior Healthcare Auditor to join our team! The Junior Healthcare Auditor will work to support the Department of Veterans Affairs - Financial Audit of Invoices and Billing Practices under VA's Medical Disability Examination (MDEs) Contracts, specifically travel-related invoices. This is aremote position.

The Junior Healthcare Auditor will be successful by: being detail-oriented, demonstrating the ability to work independently with supervisory review, maintaining connectivity and access to the VA network and required systems, maintaining access to the MDE Vendor portals, and completing objective evaluations of medical records and claims as they pertain to fraud, waste, and abuse with supervision.

Within the first 90 days, success entails demonstrating the ability to conduct independent, standards-based invoice audits and document the results in a detailed and accurate manner, based on established criteria, with regular supervisory review. Additionally, the Junior Healthcare Auditor should demonstrate the ability to prepare assigned audit documentation and actively participate and contribute to audit team planning sessions and post-audit reviews.

• Independently evaluates and documents observations and findings based on reviews of travel records and medical claims as they pertain to fraud, waste, and abuse with supervision
• Completes medical record reviews using knowledge of medical procedures (e.g., Medicare policies, coding guidelines, etc.) as assigned
• Utilizes 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
• Develops and maintains a thorough understanding of applicable laws, rules, regulations, coding and billing standards, VA policies and contractual provisions, and related requirements to perform criteria-based audits
• Prepares audit working paper documentation supporting fieldwork and conclusions in accordance with GAGAS standards as assigned
• Engages with team members to gather requirements and validate results
• Works independently and as part of an auditing team, supporting comprehensive audits of contractors' electronic medical records, other documentation, and invoices

• Must be eligible to obtain a Veterans Affairs Public Trust Clearance (NACI background investigation)
• 1 year relevant clinical or healthcare auditing experience, including clinical documentation and coding
• Healthcare auditing, regulatory compliance or a similar combination of education and experience will be considered
• Excellent communication skills, both written and verbal, and proficiency in MS Word, Excel, and PowerPoint are required.
• Comfortable managing multiple, variable tasks with limited supervision within targeted timelines and thriving in a demanding, quickly changing environment

• Experience in auditing in accordance with professional standards and industry best practices
• Knowledge of government payor practices, guidelines and procedures; knowledge of CPT, ICD-9, ICD-10, and HCPCS coding required
• Healthcare auditing, regulatory compliance, or a similar combination of education and experience will be considered

CATHEXIS offers competitive compensation packages to all eligible employees. Our goal is to provide a compensation package that reflects the value you bring to our team, is competitive with market rates, and promotes your financial security and personal well-being. The annual salary range for this role is $50,000 - $65,000. Please note that the salary information provided is a general guideline. CATHEXIS considers various factors in its final offer, including location, qualifications, experience, and skills.

CATHEXIS is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. 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@cathexiscorp.com.