ATAW99-2024-00297-Audit & Investigative Analyst-Cheyenne

US Government, 048-Div. of Healthcare Financing - Quality Assurance

Open Until Filled

GENERAL DESCRIPTION: 

The Wyoming Department of Health, Division of Healthcare Financing (DHCF), Program Integrity (PI) Section is seeking a talented professional to join our team as a PI Audit/Investigation AnalystThis is an excellent opportunity for someone with strong analytical and problem-solving skills who is interested in building a career in the Medicaid audit, investigation, and compliance space.
 
The PI Audit/Investigation analyst is responsible for planning, directing, administering, and reporting on State Plan provider audits and investigations, provider self-reporting, and provider self-audits. This position reports to the Program Integrity Audit, Investigation, and Data Management Supervisor.
 
This position is an At-Will Employment Contract (AWEC) and includes a single Health Insurance plan. This position pays for actual hours worked and is limited to 40 hours per week. This position does not include paid vacation time, paid sick time, paid holidays, family health insurance, retirement, or other benefits. These items are not negotiable by the hiring manager.

Human Resource Contact: wdhrecruit@wyo.gov

ESSENTIAL FUNCTIONS:  The listed functions are illustrative only and are not intended to describe every function which may be performed at the job level.

Facilitate Audit and Investigative Operations and Quality & Performance Standards

  • Plan, conduct, and report on independent audits/investigations of Wyoming Medicaid State Plan providers
  • Develop Program Integrity auditing/investigation standards, policies, and procedures for planning, organizing, conducting, and documenting audits/investigations
  • Identify resources available for successful and timely completion of audits/investigations; serve as lead audit/investigator for desk and field audits/investigations; assign tasks and monitor the progress of audit/investigation teams; document sampling methods
  • Obtain and review audit/investigation documentation, perform audit/investigation duties, make remediation and corrective action plans based on audit/investigation findings
  • Draft initial and final findings report program recommendations, corrective action plans, etc.
  • Make independent recommendations for the initiation of overpayment recovery and/or payment suspension actions based on audit/investigative findings
  • Testify on audit/investigation findings at contested case hearings and civil or criminal legal proceedings
  • Make recommendations and identify areas requiring further investigation by the Audit, Investigation, and Data Management Supervisor
  • Assist Program Integrity leadership in reviewing and updating Wyoming Medicaid Rules, regulations, policies, and procedures to introduce and facilitate electronic submission of information and reporting by providers using the fraud, waste, and abuse case management provider portal

Review and Interpret Data Analytics

  • Perform preliminary studies, random sampling of Medicaid claims, data mining, data analysis, data organization, and evaluation of results and findings with tables, charts, graphs, written reports, and white papers
  • Monitor claims system edits and communicate recommendations verbally and in formal written documents for system edit remediation when anomalies or vulnerabilities are identified related to billing errors or waste of program services and resources
  • Report provider non-compliance related to waste and abuse verbally and in formal written documents to PI and Division leadership

Develop Audit/Investigation Strategy

  • Identify audit/investigation areas and the execution of audit/investigation activities to measure provider compliance with Medicaid requirements, rules, and policies
  • Conduct “planned” audits/investigations of Medicaid State Plan provider groups
  • Draft preliminary audit/investigation plans including type, objectives, authority, background, review period, sampling method, timeline for completion, provider notification, and all communication of findings
  • Draft and deliver audit/investigation reporting, summaries, and findings
  • Conduct and support desk and provider field audits/investigations

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