Senior Medical Audit Specialist

At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, **Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership**, we foster a workplace where people feel supported, respected, and empowered to make an impact.* Generous state-paid to offset insurance premiums.* A wide selection of with no pre-existing condition exclusions.* for health care and dependent care.* with employer contributions.* 11 paid holidays annually.* 15 days of vacation and 15 days of sick leave in the first year.* Longevity Bonus recognizing years of public service.* Public Service Loan Forgiveness eligibility and tuition reimbursement.* Wellness benefits, including an on-site gym and fitness center discounts.The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office. **Position Purpose**The Senior Medical Audit Specialist plays a critical role in safeguarding the integrity of healthcare services by providing clinical expertise in conducting audits and investigations to combat fraud, waste, and abuse. This position ensures compliance with OHCA policies, state statutes, and federal regulations through detailed analysis of billed services and documentation. By collaborating with internal and external stakeholders, the Senior Medical Audit Specialist helps to promote accountability and transparency in billing practices, supporting the overall mission of the Oklahoma Health Care Authority to provide better health and care for Oklahomans. Performs analysis and evaluation of billed services including claims and documentation to ensure all HCA policy requirements are met and services are clinically/medically appropriate.Other duties as assigned.Knowledge, Skills, Abilities and Competency RequirementsThe Senior Medical Audit Specialist requires in-depth knowledge of healthcare policies, state and federal regulations, and audit processes, as well as the ability to analyze complex billing data and ensure compliance. Strong communication and collaboration skills are essential to effectively convey audit findings and work with various stakeholders. This role demands strategic problem-solving and organizational skills to manage multiple tasks and resolve complex issues.**\*\*To be considered for this position your application must include a resume/CV with complete work and education history.\*\*****Education and/or Experience:*** Current professional license as a Registered Nurse (RN), Dental Hygienist (RDH), Behavioral Health practitioner and 5 years of professional experience AND* General understanding of coding principles (CPT, HCPCS, ICD-10 and /or DRG)* There is no substitution for licensure.**Preference Qualifications Include:*** Certifications in any of the following areas: Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC)* Experience with Medicaid and Medicare billing audits* Experience in medical review, auditing, utilization review, compliance or regulatory work.**Physical Demands and Work Environment**Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.**Accommodation Statement**The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at View phone number on click.appcast.io.**Notice to applicants:**Please add View email address on click.appcast.io to the address book or "safe-senders" list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application, you can contact the HR team at View phone number on click.appcast.io.**Note:** Applications will be accepted until 11:59 PM on the day prior to the posting end date above.**Current State of Oklahoma employees** must apply for open positions internally through Workday .****The best-fitting Korn Ferry competencies for this position include Ensures Accountability, as the role focuses on enforcing compliance and managing responsibilities, and Collaborates, given the need for cross-functional teamwork and stakeholder engagement. #J-18808-Ljbffr Oklahoma Watch Inc.