Senior Medical Audit Specialist

About the role

Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership.

Position Purpose: The Senior Medical Audit Specialist plays a critical role in safeguarding the integrity of healthcare services by providing clinical expertise in conducting audits and investigations to combat fraud, waste, and abuse. This position ensures compliance with OHCA policies, state statutes, and federal regulations through detailed analysis of billed services and documentation. By collaborating with internal and external stakeholders, the Senior Medical Audit Specialist helps to promote accountability and transparency in billing practices, supporting the overall mission of the Oklahoma Health Care Authority to provide better health and care for Oklahomans.

Why You’ll Love Working Here: At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership, we foster a workplace where people feel supported, respected, and empowered to make an impact.

Responsibilities

• Provide clinical expertise in conducting investigations and completing comprehensive clinical audits in an effort to combat fraud, waste, and abuse.
• Ensure billing compliance with OHCA policy, state statutes, and federal regulations.
• Perform analysis and evaluation of billed services including claims and documentation to ensure all HCA policy requirements are met and services are clinically/medically appropriate.
• Collaborate with others across the unit, organization, and external entities to evaluate audit results and make referrals to appropriate parties.
• Communicate audit findings to all stakeholders.
• Represent the Provider Audits Unit before an Administrative Law Judge (ALJ) and in legal proceedings regarding any general provider appeals, in an informed and professional manner.
• Maintain licensure and certifications.
• Perform other duties as assigned.

Requirements

Possession of a valid permanent Oklahoma license as a Registered Nurse (RN) as approved by the Oklahoma Board of Nursing or Registered Nurse License recognized by the Enhanced Nurse Licensure Compact (eNLC) AND 5 years of professional experience as a registered nurse. There is no substitution for licensure.

Qualifications

• Certifications in any of the following areas: Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC)
• General understanding of coding principles (CPT, HCPCS, ICD-10 and/or DRG)
• Experience with Medicaid and Medicare billing audits
• Experience in medical review, auditing, utilization review, compliance or regulatory work

Skills

The Senior Medical Audit Specialist requires in-depth knowledge of healthcare policies, state and federal regulations, and audit processes, as well as the ability to analyze complex billing data and ensure compliance. Strong communication and collaboration skills are essential to effectively convey audit findings and work with various stakeholders. This role demands strategic problem-solving and organizational skills to manage multiple tasks and resolve complex issues. The best‑fitting Korn Ferry competencies for this position include Ensures Accountability and Collaborates.

Benefits

• Generous state-paid benefit allowance to offset insurance premiums
• A wide selection of insurance plans with no pre-existing condition exclusions
• Flexible Spending Accounts for health care and dependent care
• Retirement Savings Plan with employer contributions
• 11 paid holidays annually
• 15 days of vacation and 15 days of sick leave in the first year
• Longevity Bonus recognizing years of public service
• Public Service Loan Forgiveness eligibility and tuition reimbursement
• Wellness benefits, including an on-site gym and fitness center discounts

Pay

$78,465.00/annual

Schedule

Work Schedule: Monday – Friday; Primary Hours: 8:00 a.m. – 5:00 p.m.