Medical Audit Specialist (Behavioral Health)

Medical Audit Specialist (Behavioral Health)

Agency: 807 HEALTH CARE AUTHORITY

Supervisory Organization: Program Integrity & Account

Job Posting End Date: Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank):

Job Type: Regular

Compensation: $65,607.00/annual

Why You'll Love Working Here

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, we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.

Let's Talk Benefits

We know your great work deserves great support. Here's a snapshot of what we offer for all eligible employees.

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan 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.

Job Description

Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $65,607.00/annual

Work Schedule: Monday – Friday

Primary Hours: 8:00 a.m. – 5:00 p.m.

Agency/Division Information

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 Behavioral Health Medical Audit Specialist ensures compliance with OHCA policies, state statutes, and federal regulations by providing clinical expertise in conducting comprehensive audits and investigations to identify and address fraud, waste, and abuse within behavioral health services. The role involves evaluating the clinical appropriateness of billed services, analyzing documentation, and collaborating with internal and external stakeholders to communicate findings and make necessary referrals. This position plays a critical role in maintaining the integrity of Medicaid behavioral health services while supporting the agency's mission of providing Oklahomans with better health care.

Principal Activities May Include:

• Provide clinical expertise in conducting investigations and completing comprehensive clinical audits in an effort to combat fraud, waste, and abuse.
• Ensure billing compliance with OHCA policy, state statutes, and federal regulations.
• 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.
• Collaborate with others across the unit, organization, and external entities to evaluate audit results and make referrals to appropriate parties.
• Communicate audit findings to all stakeholders.
• Represent the Provider Audits Unit in ALJ legal proceedings in an informed and professional manner.
• Maintain licensure and certifications.
• Other duties as assigned.

Knowledge, Skills, Abilities and Competency Requirements

The Behavioral Health Medical Audit Specialist requires in-depth knowledge of agency policies, state and federal regulations, and behavioral health clinical practices to effectively conduct audits and investigations. Strong analytical skills and attention to detail are essential for evaluating service appropriateness and identifying non-compliance. Additionally, excellent communication and collaboration abilities are necessary to convey findings to stakeholders and maintain productive relationships. The most fitting competencies for this role are Manages Complexity (analyzing complex issues) and Ensures Accountability (holding others to compliance standards).

Education and/or Experience:

• Current professional licensure in Behavioral Health and 3 years of professional experience.

Preference Qualifications Include:

• Certifications in any of the following areas: Certified Fraud Examiner (CFE), Certified Professional Medical Auditor (CPMA), Certification in Healthcare Compliance (CHC), or Project Management Professional (PMP) or Lean Six Sigma Certification

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 Jobs Hub.

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.