Lead Healthcare Auditor (req-152)

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, 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 Lead Healthcare Auditor to join our team! The Lead Healthcare Auditor will support the Department of Veterans Affairs in ensuring proper billing practices and reducing fraud, waste, and abuse under the VA’s Medical Disability Examination (MDE) Contracts. This position offers the opportunity to contribute independently and collaboratively to high-impact audit operations, working with VA systems and vendor portals to ensure compliance and quality standards are met.

Responsibilities:

• Responsible for supervision and supervisory review of independent and objective evaluation and documentation of observations/findings based on reviews of medical records and claims as they pertains to fraud, waste, and abuse 
• Complete proactive medical record reviews using knowledge of medical procedures, Medicare policies, coding guidelines, etc. 
• Utilize coding conventions, detect fraud schemes, evaluate reimbursement practices, and apply pertinent laws, rules, and regulations to identify fraudulent billing patterns in claims, documentation, authorization for services, etc. 
• Maintain a thorough understanding of applicable laws, rules, regulations, coding and billing standards, VA policies and contractual provisions, and related requirements necessary to perform criteria-based audits 
• Coordinate the preparation of and be responsible for the completion of audit working paper documentation supporting fieldwork and conclusions by GAGAS standards 
• Encourage active team engagement with and between team members to gather requirements and validate results 
• Prepare written summaries of audit fieldwork results and conclusions for inclusion in formal written audit reports  
• Perform root-cause analysis and identify corrective and preventative actions and opportunities for improvement in support of ad hoc reports and Post-Audit Reform and Recovery Summaries 
• Work independently as part of the Audit Leadership Team, supporting comprehensive audits of contractors’ electronic medical records, other documentation, and invoices 
• Perform other duties as required

Supervisory Responsibilities 

•  Leads audit projects from planning through to follow-up stages. 

• Mentors the audit team, sets goals and provides training to maintain best practices. 

• Cultivates a team-focused work environment and encourages professional development. 

• Collaborates with other departments to implement improvements based on audit findings. 

• Plays a crucial role in maintaining the accuracy of patient care documentation and the organization's financial integrity through strategic leadership and effective management. 

Requirements:

• Must have an active Public Trust or the ability to obtain and maintain a Public Trust, which requires U.S. citizenship, a favorable background check (including criminal, credit, and employment history)
• Registered nurse or other licensed medical professional or Bachelor’s Degree: A bachelor's degree (in lieu of a bachelor's degree, an additional 4 years of relevant work experience) in health information management, Nursing, Healthcare Administration, or a related field is typically required.
• Must have five plus (5+) years of healthcare auditing experience, including clinical, coding, or experience with both 
• Experience auditing by professional standards and industry best practices is required
• Knowledge of government payor practices, guidelines and procedures; knowledge of CPT, ICD-9, ICD-10, and HCPCS coding required 
• Excellent communication skills, both written and verbal, and proficiency in MS Word, Excel, and PowerPoint required 
• Demonstrated ability to work ind