What are the responsibilities and job description for the Audit Analyst - Medicaid position at Briljent?
Job Type
Full-time
Description
Briljent is seeking an Audit Analyst with multi-functional responsibilities supporting both the Program Integrity Audit Team and the Analytics Team. This role requires flexibility to float between teams as needed and play a key role in Medicaid post-payment audit activities, provider engagement, data analysis, and recovery efforts.
The ideal candidate brings strong audit and medical coding experience, a solid understanding of Medicaid policies, and the ability to collaborate effectively with internal teams, state agency staff, and providers.
Essential Duties & Responsibilities
This position requires the ability to remain in a stationary position for extended periods of time and to use a computer and other standard office equipment. Occasional travel may be required, including the ability to navigate airports and client sites. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes perspective and collaboration are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status, or any other basis protected by federal, state, or local law, regulation, or ordinance.
Full-time
Description
Briljent is seeking an Audit Analyst with multi-functional responsibilities supporting both the Program Integrity Audit Team and the Analytics Team. This role requires flexibility to float between teams as needed and play a key role in Medicaid post-payment audit activities, provider engagement, data analysis, and recovery efforts.
The ideal candidate brings strong audit and medical coding experience, a solid understanding of Medicaid policies, and the ability to collaborate effectively with internal teams, state agency staff, and providers.
Essential Duties & Responsibilities
- Review surveillance and utilization reports; analyze findings and make recommendations
- Perform ad hoc assignments related to Medicaid reimbursement
- Review medical records for accuracy, completeness, and compliance with professional standards
- Develop and maintain working knowledge of Medicaid statutes, regulations, provider billing manuals, and related policies
- Use IHCP policy, audit expertise, and record review experience to recommend new audits and algorithms to improve ROI and increase recoveries
- Interpret and analyze healthcare data to support audit outcomes
- Assist management in developing policies, procedures, workflows, and processes for Audit and Case Disposition functions
- Monitor post-payment audit cases within the case management system and ensure timely follow-up and resolution
- Collaborate with Program Integrity team members to determine case status and final disposition
- Prepare provider demand letters and notifications; ensure appropriate approvals prior to distribution
- Respond to provider inquiries in a prompt, professional, and provider-friendly manner
- Coordinate provider appeals with Audit Vendors as needed
- Assist with notification, tracking, collection, and reporting of overpayment recoveries
- Process provider payments and reconcile monthly recoveries
- Analyze and report collections and un-recoveries for quarterly CMS-64 reporting
- Support configuration, testing, implementation, and ongoing operations of the case tracking system
- Develop educational materials for providers in collaboration with team members
- Identify urgent issues, escalate appropriately, and manage through resolution with clear and timely communication
- Maintain professional working relationships with state agency staff and providers
- Ability to manage multiple deadlines and prioritize competing assignments
- Strong analytical and problem-solving skills
- Proficiency with Microsoft Word and Excel
- Excellent verbal and written communication skills
- Highly organized with strong attention to detail and accuracy
- Self-directed with the ability to shift priorities while maintaining productivity
- Collaborative approach and ability to work effectively in a team environment
- Bachelor’s degree in Health Information Administration or a related healthcare field
- 3–5 years of experience in medical coding
- Strong understanding of healthcare claims and code sets (CPT, ICD, HCPCS)
- Experience and knowledge of State and Federal healthcare regulations
- Knowledge of Medicaid reimbursement and coverage policies
- Experience working on quality improvement initiatives
- Prior experience supporting audit, utilization review, or program integrity activities
This position requires the ability to remain in a stationary position for extended periods of time and to use a computer and other standard office equipment. Occasional travel may be required, including the ability to navigate airports and client sites. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes perspective and collaboration are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status, or any other basis protected by federal, state, or local law, regulation, or ordinance.