The Program Integrity Auditor reviews records for medical, behavioral, transportation, and other healthcare providers. This role evaluates coding and documentation accuracy, identifies billing patterns and potential fraud, waste, and abuse (FWA), and recommends follow-up actions such as provider education, recoupment, rebilling, or referral to regulators. The position also supports audit documentation, reporting, and provider education to ensure compliance with state and federal requirements.
3-5 years of experience reviewing and interpreting claims data, medical records, and supporting documentation.
3-5 years of experience with standard coding guidelines including CPT, HCPCS, and ICD-10.
Active CPC, CCS, or CPMA certification.
Associate’s degree or equivalent experience (2+ years of relevant experience plus a high school diploma or GED).
Preferred experience includes:
- Auditing experience
- Medicaid and/or health plan experience, including AHCCCS
- QuickBase experience
- Strong analytical and critical thinking skills
- Strong attention to detail
- Ability to collaborate and work independently
- Excellent presentation and communication skills
- Adaptability in a flexible environment
Full-time benefits package including:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources based on eligibility
Eligible for bonus, commission, or short-term incentive program in addition to base pay.
Location
Phoenix, Arizona, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$46,988 - $122,400
Remote work allowed
No
Posted
2 months ago