Medicaid Fraud Auditor

Peraton

. Research and interpret federal and state Medicaid requirements .

Posted 9/30/2026full-timeRemote • United StatesMid-LevelSenior💰 $66,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting Medicaid audits, including compliance, financial, and program integrity reviews. Proficient in analyzing claims, identifying overpayments, and developing audit procedures while maintaining accurate documentation and reporting.

Highest-signal resume keywords

Medicaid Audit ExperienceClaims AnalysisAudit Procedure DevelopmentStrong Written CommunicationProfessional Certification (CPA, CIA, CFE, CHC, CPC)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Audit ProceduresClaims AnalysisFinancial Record EvaluationOverpayment IdentificationRegulatory ResearchData AnalysisAudit DocumentationStatutory InterpretationRisk AssessmentAudit Findings Development

Soft Skills

Analytical SkillsOrganizational SkillsProblem-Solving SkillsIndependent JudgmentCommunication Skills

Tools & Technologies

Microsoft ExcelMicrosoft WordMicrosoft PowerPoint

Certifications & Qualifications

CPACIACFECHCCPC

Industry Keywords

Medicaid RequirementsHealthcare ComplianceProgram IntegrityBilling IrregularitiesProvider TypesMedicaid Provider ComplianceInternal AuditsFinancial AuditsHealthcare AdministrationPublic Health

About the role

Key responsibilities & impact

Research and interpret federal and state Medicaid requirements
Develop appropriate audit procedures
Analyze claims and supporting documentation
Identify and substantiate exceptions
Determine potential overpayments
Communicate audit conclusions clearly
Conduct Medicaid compliance, payment, provider, and focused audits across varied provider types, services, and program requirements
Independently perform audits from planning and procedure development through testing, analysis, findings, and completion
Research statutes, regulations, Medicaid manuals, provider requirements, policies, and other applicable guidance
Develop audit testing procedures addressing identified risks and Medicaid requirements
Analyze claims, payment data, medical or service documentation, financial records, provider records, and other information
Calculate or validate potential Medicaid overpayments
Evaluate complex circumstances and exercise professional judgment
Develop well-supported audit findings identifying requirements, conditions, evidence, and financial impact
Maintain complete and accurate audit workpapers and case files
Conduct interviews and obtain information from providers, beneficiaries/recipients, and other relevant individuals
Prepare audit reports, Law Enforcement referral summaries, and other written products
Support Lead and Manager as needed and mentor new staff
Participate in meetings and attend training

Requirements

What you’ll need

5 years with BS/BA; 3 years with MS/MA; 0 years with PhD
Bachelor's degree in accounting, finance, business, healthcare administration, public health, health science, law, or a related field, or an equivalent combination of education and relevant professional experience
Experience conducting Medicaid, Medicare, healthcare, compliance, financial, internal, or program integrity audits
Experience independently planning, conducting, documenting, and completing audits or complex reviews
Ability to research and interpret laws, regulations, policies, contractual requirements, and other authoritative guidance and apply those requirements to audit findings
Experience analyzing healthcare claims, billing records, financial information, medical/service documentation, or other provider records
Experience identifying and documenting noncompliance, improper payments, billing irregularities, or potential overpayments
Strong written communication skills and ability to prepare professional audit correspondence, findings, reports, and technical documentation
Strong analytical, organizational, research, and problem-solving skills
Ability to exercise independent judgment within established policies, procedures, and audit methodologies
Ability to manage multiple assignments, establish priorities, meet deadlines, and maintain accurate audit documentation
Intermediate to advanced proficiency with Microsoft Excel, Word, and PowerPoint
Must be a US Citizen
Direct Medicaid audit or Medicaid Program Integrity experience
Experience researching and applying state-specific Medicaid requirements
Experience auditing hospitals, pharmacies, laboratories, physicians, dental providers, behavioral health providers, personal care providers, managed care organizations, or other Medicaid provider types
Experience with Medicaid provider compliance and billing requirements
Experience identifying Medicaid overpayments
Professional certification such as CPA, CIA, CFE, CHC, CPC, or a comparable audit, fraud, healthcare, or compliance credential

Benefits

Comp & perks

Eligible for overtime, shift differential, and a discretionary bonus in addition to base pay
Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law