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Posted: 10/16/2026Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting compliance audits and data analysis within Medicaid programs, ensuring adherence to federal and state regulations. Proficient in identifying compliance exceptions and presenting findings effectively.
Highest-signal resume keywords
Medicaid Compliance AuditingData AnalysisResearch SkillsMicrosoft ExcelHealthcare Auditing
About the role
Key responsibilities & impact- Conduct audits and reviews of Medicaid programs for compliance with federal and state requirements
- Recover over-payments resulting from non-compliance
- Research and interpret laws and regulations
- Perform data analysis and draw conclusions
- Conduct compliance audits, claim submission audits, and focused audits
- Organize and analyze billing patterns
- Conduct interviews and obtain statements from beneficiaries, recipients, and others
- Identify findings, compliance exceptions, conflicts of interest, and improper payments
- Organize case files and document all steps taken
- Provide progress reports and audit status updates
- Present data-verified concerns and regulatory violations, including fraud schemes
- Compose correspondence, reports, and referral summary letters
- Work independently or as part of a team under general supervision
- Ensure projects are timely, complete, and accurate
- Participate in meetings and attend training
Requirements
What you’ll need- 2 years with BS/BA or 6 years with a high school diploma
- Experience in accounting or a closely related business field, law enforcement, health science, or a related field
- Knowledge of internal audit/investigative policies and operating principles
- Understanding of Medicare/Medicaid or healthcare auditing
- Strong research and analytical skills
- Intermediate to advanced knowledge of Microsoft Office tools, including Excel
- Must be a US Citizen
- Candidates must reside within the Northeast Jurisdiction: Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, District of Columbia, or Virginia
Benefits
Comp & perks- Employees may be eligible for overtime
- Shift differential may be available
- Discretionary bonus may be available
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Compliance AuditsData AnalysisBilling Pattern AnalysisInternal Audit PoliciesRegulatory Interpretation
Soft Skills
Organizational SkillsCommunication SkillsTeam CollaborationIndependent Work
Tools & Technologies
Microsoft Office
Industry Keywords
MedicaidMedicareHealthcareFraud DetectionAudit Reporting