Medicaid Fraud Auditor – Team Lead

Peraton

. Oversee the development and progression of Medicaid audits from initiation through completion .

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

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in Medicaid audits, including planning, conducting, and documenting findings while ensuring compliance with federal and state requirements. Possesses strong communication and organizational skills to effectively mentor staff and educate stakeholders on program safeguard matters.

Highest-signal resume keywords

Medicaid Audit ExperienceRegulatory InterpretationAudit MethodologyProfessional Certification (CPA, CIA, CFE, CHC, CPC)Claims Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Audit TestingFindings DevelopmentQuality ControlDocumentationResearch and AnalysisIdentifying NoncomplianceBilling IrregularitiesOverpayment IdentificationProgram Integrity AuditsHealthcare Compliance Audits

Soft Skills

Strong Written CommunicationStrong Verbal CommunicationOrganizational SkillsMentoringTeam Collaboration

Tools & Technologies

Microsoft OfficeWMM/UCM

Certifications & Qualifications

CPACIACFECHCCPC

Industry Keywords

Medicaid RequirementsHealthcare AuditsFraud DetectionProvider ComplianceBilling Requirements

About the role

Key responsibilities & impact

Oversee the development and progression of Medicaid audits from initiation through completion
Plan audits, conduct audit testing and analysis, develop findings, communicate with providers, and issue final finding reports
Provide day-to-day oversight and direction to Auditors conducting Medicaid audits
Ensure audits are planned, progressed, documented, reviewed, and completed according to federal and state Medicaid requirements and established audit methodologies
Provide technical guidance and consultation on Medicaid requirements, audit methodology, regulatory interpretation, claims analysis, documentation, and findings development
Review individual workloads during monthly auditor meetings, assist with prioritization, and conduct quality control for staff
Establish priorities and monitor staff workloads to align resources with audit requirements and metrics
Monitor the quality of WMM/UCM
Monitor timeliness of audit updates and escalate issues to management as necessary
Mentor team members in identifying previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development
Act as a point of contact for the manager
Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
Coordinate with other designated leads for coverage when necessary

Requirements

What you’ll need

Minimum of 8 years with BS/BA; or 12 years with a HS Diploma/equivalent
Experience conducting Medicaid, Medicare, healthcare, compliance, financial, internal, or program integrity audits
Experience leading staff in identifying and documenting noncompliance, improper payments, billing irregularities, or potential overpayments
Strong written, verbal communication and organization skills
Strong PC knowledge and Microsoft Office tools
US Citizen
Direct Medicaid audit or Medicaid Program Integrity experience desirable
Experience researching and applying state-specific Medicaid requirements desirable
Experience auditing hospitals, pharmacies, laboratories, physicians, dental providers, behavioral health providers, personal care providers, managed care organizations, or other Medicaid provider types desirable
Experience with Medicaid provider compliance and billing requirements desirable
Experience identifying Medicaid overpayments desirable
Professional certification such as CPA, CIA, CFE, CHC, CPC, or a comparable audit, fraud, healthcare, or compliance credential preferred
Ability to perform research and draw conclusions
Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
Ability to organize a case file and accurately and thoroughly document all steps taken
Ability to compose correspondence, reports, and referral summary letters
Ability to educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters
Ability to communicate effectively, internally and externally
Ability to interpret laws and regulations
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
Ability to handle confidential material
Ability to report work activity on a timely basis
Ability to work independently and as a member of a team
Ability to attend meetings, training, and conferences; overnight travel required
Ability to document QC results in WMM according to record type
Ability to coordinate coverage with other designated leads when out of the office

Benefits

Comp & perks

Potential eligibility for overtime
Potential eligibility for shift differential
Potential eligibility for a discretionary bonus