Requirements

The Audit Case Team Lead manages the comprehensive audit function, overseeing provider and member audits from case initiation through final disposition and recovery. This position requires strong audit methodology expertise, team leadership skills, and the ability to manage complex investigations with significant financial implications. The Team Lead works closely with the State to ensure audit quality, compliance, and effective overpayment recovery.

Lead audit team in conducting comprehensive provider and member audits

Develop audit plans, methodologies, and sampling strategies

Review and approve audit findings and overpayment calculations

Prepare audit recommendations for State review and approval

Coordinate with clinical staff on medical necessity determinations

Manage case progression from preliminary investigation through final disposition

Ensure audit documentation meets State and federal standards

Supervise audit analysts and provide training and mentorship

Interface with providers regarding audit findings and appeals

Track audit performance metrics and recovery rates

Participate in quarterly business planning and fraud trend analysis

Attend bi-weekly status meetings and provide audit updates to State

Qualifications

Bachelor's degree in Accounting, Finance, Healthcare Administration, or related field

Professional certifications required: CPA, CFE, CIA, or CHC

Multiple certifications preferred

Minimum 5 years of healthcare audit experience, preferably in Medicaid program integrity

Minimum 3 years of supervisory or team lead experience

Proven track record of identifying and quantifying healthcare fraud and overpayments

Experience with medical record review and clinical documentation analysis

Demonstrated success managing complex multi-provider audits

Knowledge and Skills

Expert knowledge of audit methodologies and sampling techniques

Deep understanding of Medicaid billing rules and documentation requirements

Proficiency with medical coding systems (CPT, HCPCS, ICD-10)

Knowledge of fraud schemes and abuse patterns by provider @type

Strong analytical and investigative skills

Excellent written and verbal communication abilities

Proficiency with data analytics tools and case management systems

Leadership and team development capabilities

Other Requirements

Full-time dedication to Indiana contract

Available for in-person meetings at State offices as required

Successfully pass background check

Subject to State approval

Commence.AI is committed toprovidingequal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation toparticipatein the application process due to a disability, please contact Human Resources at (757) 306-4920 or

hr@commence.ai.Pleasenote that unless you are requesting accommodation, all applications must besubmittedthrough our online application system.**

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Medicaid Audit Team Lead