Lead Healthcare Auditor / Program Integrity SME (CFE or CPA Preferred)

Company Overview
SBS-Corp is a dynamic consulting firm specializing in providing expert staffing solutions to meet diverse client IT requirements. We are committed to delivering exceptional service and fostering professional growth for our team members. Job Summary
We are seeking a highly motivated and experienced Lead Healthcare Auditor / Program Integrity Subject Matter Expert (SME) with a strong background in healthcare compliance, auditing, and program integrity. The ideal candidate will possess a CPA or Certified Fraud Examiner (CFE) credential and demonstrate expertise in healthcare regulations, coding, and compliance management. This role offers an exciting opportunity to lead audit initiatives, ensure adherence to industry standards, and contribute to the integrity of healthcare programs. Responsibilities

• Lead comprehensive healthcare audits focusing on program integrity, fraud detection, and compliance with federal and state regulations.
• Review medical claims, billing practices, and documentation for accuracy and adherence to HIPAA standards, and regulations.
• Evaluate Medicare and other government program claims to identify potential fraud or abuse issues.
• Develop and implement audit strategies aligned with CMS and payor provider environments and standards and other accreditation requirements.
• Collaborate with cross-functional teams to enhance compliance management processes and improve internal controls.
• Prepare detailed audit reports, findings, and recommendations for senior management and regulatory agencies.
• Stay current on evolving healthcare regulations, coding updates, and industry best practices to maintain audit effectiveness. Qualifications
• Proven experience as a healthcare auditor or compliance specialist with a focus on program integrity.
• Certified Fraud Examiner (CFE) or Certified Public Accountant (CPA) designation preferred.
• Deep knowledge of HIPAA regulations, Medicare policies and standards.
• Strong understanding of healthcare billing processes, claims review procedures, and compliance management tools.
• Excellent analytical skills with the ability to interpret complex data sets and regulatory guidelines.
• Exceptional communication skills for preparing reports and collaborating with diverse teams.
• Ability to manage multiple projects efficiently in a fast-paced environment. Join us at SBS-Corp as we drive excellence in healthcare auditing! This role empowers you to make a meaningful impact by safeguarding the integrity of vital health programs while advancing your professional expertise in a supportive environment dedicated to growth and success.
• Responsibilities may include:
• Supporting audit planning and execution
• Reviewing compliance with operational and payment requirements
• Conducting documentation and process reviews
• Supporting audit findings, reports, and corrective action recommendations
• Assisting with quality assurance and audit lifecycle activities

This is initially a contingent consulting opportunity with potential for longer-term engagement.

Remote support anticipated.

Please submit resume and brief summary of relevant healthcare audit/program integrity experience.

Pay: $145,000.00 - $180,000.00 per year

Application Question(s):

• Do you hold CPA or CFE

Years of healthcare audit experience?
Availability within 2-3 wees?
Remote consulting OK?

Work Location: Remote