New

Medicaid Auditor

22nd Century Technologies, Inc.
Pay: $35 to $40/hour on w2
United States, Wisconsin, Madison
301 South Bedford Street (Show on map)
Feb 03, 2026
Job Title: Medicaid Auditor Location: Madison, WI 53707 Job Mode: On-Site Pay rate: $30 to $35/hour on w2 without benefits Shift hours: Monday through Friday Day Shift Job Description: Conduct on-site and desk reviews of Rural Health Clinics (RHC) and, in rare occasions, Federally Qualified Health Centers (FQHC). Set reimbursement rates for RHC and FQHC providers, developing and using appropriate reimbursement methodology which reflects Medicaid policy and cost reports to determine the amount of reimbursement each RHC or FQHC is to receive for services provided to Medicaid recipients. When conducting RHC audits, verify encounter data, medical records, account details, cash receipts, and HMO detail; review provider's cost report expenses for RHC's with fewer than 50 beds; calculate the encounter rate using either the Trial Balance and Medicare Cost Report, Prospective Payment System (PPS) rate, or Medicare Upper Payment Limit, and add the Health Care Professional Shortage Area (HPSA) bonus (as appropriate); and make adjustments to submitted cost reports to determine if there is an amount owed to/from the RHC. When conducting FQHC audits, verify reported costs; encounters; revenues from Medicaid fee for service (FFS) and HMOs, Medicare, Medicaid recipient copayments, and other third parties; and make adjustments to submitted cost reports to determine if there is an amount owed to/from the FQHC. If a provider submits an interim report, verify the information submitted on the cost report. Complete a financial transaction form and enter the information into PRISM. Write a letter to be mailed to the provider informing them of their interim payment amount Research the body of federal and state Medicaid statutes, codes, and other pertinent regulations and laws to determine and interpret legal provisions and guidelines which apply to the provider subject to audit and identify pertinent audit and investigative issues. Write-up each legal question identified that relates to the statutes, administrative codes, or regulations to be enforced in an audit or investigation and assist the assigned Client Office of Legal Counsel in the formulation of the Office of the Inspector General (OIG) position on the legal questions posed. Develop routine and customized audit working papers and audit instruments, and establish formal or informal field audit format to be used in auditing provider. Analyze federal and state transmittals and update audit programs in concurrence with accepted audit standards and practices, for adherence to both state and federal statutes and regulations. Schedule audit with entity to be audited. Conduct entrance and exit conferences with audited entity to explain the nature and scope of the audit, the audit process, and findings. Independently and as a team member review medical records, trial balances, patient accounts, bank records, vouchers, independent audit reports, bridging worksheets, personnel and or payroll records, remittances, patient charts and other documentation to support reported items on the cost reports, to determine federal and state guidelines are being followed by provider and document findings. Collect, document, protect, preserve and freeze evidence to ensure admissibility at hearings and court proceedings. Prepare working papers, analyze documented findings, and write audit findings letters. Present preliminary audit findings, giving audited entity an opportunity to review and respond to findings. Resolve disagreements with providers about audit findings and advise or consult with Supervisor for resolution of such disagreements when auditor cannot reach resolution. Prepare final audit reports and letters with recommendations and final amount due from the provider or additional payments owed to the provider Perform any follow-up required such as preparing Promissory Notes and schedules of repayment, ensuring the set-up for collection of overpayment amounts identified and provide education to provider on Medicaid policies, reimbursement procedures and methods to improve compliance. Required Qualification: Bachelor's Degree in accounting OR professional training in accounting or auditing such as that which would be acquired by earning a Bachelor's Degree in accounting or auditing from an accredited post-secondary college/university; or commensurate experience and training. Knowledge of modern accounting and auditing theory and practices as used in complex and comprehensive audits. Knowledge of Generally Accepted Accounting Principles (GAAP) and Generally Accepted Auditing Principles and Standards and the ability to perform audits of the various health care entities. Knowledge of program, financial, and accounting systems and procedures used by the various health care entities to manage the business of the entity such as how health care providers keep patient accounts showing charges and payments and how billing clerks prepare claims for reimbursement from third party payors and the specialized governmental or industry accounting and auditing standards or audit guides used to audit the provider.