Supervisor - Audit/Investigation

Accountabilities:: Review new audits, investigations, and incoming leads to determine appropriateness, assign cases, and establish priorities based on workload and program requirements. Oversee provider vetting activities with appropriate government agencies and law enforcement partners. Review audit and investigation plans, priorities, documentation, and case-tracking records to ensure quality, completeness, and alignment with established criteria. Conduct regular file reviews and evaluate requests for information, data, reports, and correspondence prepared by auditors and investigators. Supervise and participate in investigative activities, including interviews, onsite audits or investigations, and site verification when required. Lead complex audit and investigation projects by developing strategies, coordinating stakeholder meetings, reviewing investigative actions, and documenting findings for management. Collaborate with Data and Medical Review teams to support efficient and effective audits and investigations. Prepare and present audits, investigations, overpayments, and related questions during stakeholder and case coordination meetings. Review investigative findings with team members, determine appropriate courses of action, and approve case decisions within established guidelines. Prepare and review cases for Major Case Coordination meetings and ensure investigative work meets quality assurance standards. Maintain communications with law enforcement and regulatory agencies and present or support the presentation of findings for potential further investigation, prosecution, or administrative action. Supervise and review administrative remedies such as payment suspensions, provider revocations, and provider education activities. Review and approve audit and investigation closing summaries and ensure cases are properly documented and resolved. Collect and submit information and documentation requested by internal and external stakeholders, including CMS, law enforcement, and FOIA requests. Collaborate with other program integrity contractors when required and provide testimony at legal or administrative proceedings as necessary. Manage team performance through regular feedback, formal performance reviews, coaching, engagement, motivation, and professional development. Work independently while escalating significant questions, issues, and cases when appropriate. Requirements: Bachelor’s degree required, with relevant professional experience potentially considered as a substitute where applicable. 5–7 years of relevant experience required, with 8–11 years preferred. Experience in healthcare audits, investigations, program integrity, fraud, waste and abuse, compliance, or related areas. Strong understanding of Medicare and/or Medicaid processes, healthcare program integrity, investigative practices, and applicable administrative or regulatory requirements. Demonstrated ability to evaluate complex cases, identify potential fraud, waste, abuse, or compliance issues, and determine appropriate next steps based on established criteria. Experience supervising auditors, investigators, or similar professional teams and managing workload, priorities, quality, and performance. Strong investigative judgment and analytical skills, with the ability to assess documentation, evidence, findings, and case strategies. Excellent written and verbal communication skills, including the ability to prepare reports, present findings, communicate with stakeholders, and support legal or administrative proceedings. Ability to collaborate effectively with government agencies, law enforcement, healthcare stakeholders, data teams, medical reviewers, and other program integrity partners. Strong organizational skills and attention to detail, particularly when managing multiple complex investigations and maintaining accurate case documentation. Ability to work independently, exercise sound judgment, and escalate issues appropriately. Certified Fraud Examiner (CFE) or Accredited Healthcare Anti-Fraud Investigator (AHFI) certification is preferred. Benefits: Competitive compensation based on qualifications and experience. Opportunity to contribute to healthcare program integrity and efforts addressing fraud, waste, abuse, and compliance. Professional environment focused on quality, accountability, and meaningful public-sector and healthcare outcomes. Opportunities to collaborate with regulatory agencies, law enforcement, healthcare organizations, and program integrity professionals. Team leadership and professional development opportunities. Supportive environment emphasizing engagement, performance, and continuous team development.