Auditor III

Recruitment #200210-UNCD-11



Available to current OHCA Employees and Contracted staff only

The Program Integrity and Accountability Unit is involved with program integrity efforts in an evolving health care system where public demand for economy, efficiency and accountability in government spending is ever increasing.  The unit is responsible for conducting internal performance and productivity reviews, external financial and compliance reviews of our medical providers, eligibility, financial, and compliance reviews of our program members.  Effectiveness in planning and performing audits / reviews depends on the capabilities of professional, hard-working staff who are dedicated to supporting the agency’s activities in this area. This position is also responsible for reviewing eligibility as it relates to SoonerCare/Insure Oklahoma, and evaluates compliance with applicable federal and state laws, rules, and regulations. In this position, you will function in an auditor role responsible for Medicaid Eligibility Quality Control (MEQC) audits, review of Payment  Error Rate Measurement (PERM) audits, supporting the facilitation of state and agency level eligibility audits, and maintaining thorough and current knowledge of the regulations and guidance that govern Oklahoma’s Medicaid, CHIP, and Insure Oklahoma programs. You will be responsible for accurate and timely reviews of sampled MEQC cases, review and response to PERM findings, training state and federal employees/contractors tasked with auditing our agency, completion of thorough and well-documented reports, and communication with members and agencies to obtain information necessary to complete audit activities. 

PRINCIPAL ACTIVITIES:  The principal activities include the following:
*Completes audit work and related tasks for federal MEQC audits, and other agency level audits as directed according to federal and unit guidelines.
*Reviews and provides detailed responses and appeals of PERM findings.
*Provides training and support to state and federal personnel as necessary to ensure compliance with required audits.
*Interviews Soonercare and Insure Oklahoma members, as well as providers and partner agencies, to obtain information necessary to complete MEQC, PERM, and other agency audits.
*Provides timely and thorough written and verbal feedback for the purpose of informing OHCA and DHS of errors and deficiencies, as well as communicating any need for additional information to complete a review.
*Manages audit activities according to established timelines, and coordinates all necessary contacts and documentation to ensure timely and thorough completion of audit documentation.
*Maintains exceptional knowledge of the methods to be used for completion of audits, policy/guidance application, eligibility procedures, and rules and regulations applicable to the programs.
*Completes thorough, well-documented, factual, and objective audits.
*Communicates with supervisor, manager, and other designees any information that is necessary to ensure completion of federal eligibility audits.
*Prepares audit case documents, and enters cases into PI Case Tracker as directed.
*Utilizes PI Case Tracker, and other necessary sources for monitoring audit activities, and documenting associated work activities.
*Prepares written documentation and correspondence using professional standards, and in accordance with federal guidance.
*Other duties as assigned.

Bachelor’s degree in Accounting, Finance, Business Administration, Behavioral Science, Social Science, Humanities, Public Health, or closely related field AND A minimum of two (2) years of SoonerCare/Medicaid/Insure Oklahoma eligibility determination experience. 

An equivalent combination of education and experience totaling six (6) years.

Advanced education or certification (i.e., CPA, CPIP, CIA, or CGFM) and additional years of eligibility determination can substitute for one year of the required experience.

*Federal eligibility audit experience and knowledge.
*Experience in governmental accounting or auditing.
*Eligibility systems experience.
*Exceptional knowledge of OHCA and/or DHS eligibility rules and processes.

The Oklahoma Health Care Authority complies with applicable Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335. 


Veteran’s preference points apply only for initial appointment in the classified service.