{"id":2873166,"url":"https://alion.io/job/lifelancer-program-integrity-auditor","title":"Program Integrity Auditor","company":{"id":3853997,"name":"Lifelancer","domain":"lifelancer.com","url":"https://alion.io/company/lifelancer","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":true,"listed_via":null,"ats_vendor":null,"truth_index":null},"role":"Finance","role_family":"Finance","seniority":null,"employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"posting_text","remote_working_hours":null,"hiring_geo_confidence":"explicit","locations":[],"countries":[],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":46988,"max":122400,"currency":"USD","period":"year","gross":null,"usd_annual":122400},"salary_estimate":null,"experience_years_min":null,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-10-19T18:38:15Z","employer_posted_date":null,"last_verified_at":"2026-10-19T18:38:15Z","board_verified":false,"closed_at":null,"days_open":4,"trust":{"level":"not_scored","repost_count":null,"flags":[],"days_open":4},"description":"Job Title: Program Integrity Auditor\nJob Location: Work at Home, Arizona, United States\nJob Location Type: Remote\nJob Contract Type: Full time\nJob Seniority Level: We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.\nPosition SummaryThe Program Integrity Auditor is responsible for the review of records for medical, behavioral, transportation, and other healthcare providers. The Auditor must have the ability to determine correct coding and appropriate documentation during the review of medical records. Activities include reviews/audits of provider records to ensure appropriate coding standards and documentation standards are being met. The Auditor will also be recommending follow-up action including (but not limited to) provider education, recoupment of funds or rebilling of claims, and referral to state regulators for any suspected fraud, waste, or abuse (FWA). The Auditor must also ensure that state and federal requirements are met and recognize any concerning billing patterns or trends.\nPrimary Responsibilities\nServe as an audit team member for a health plan(s) which currently administers benefits to Medicaid members across multiple lines of business including acute, behavioral health, individuals with developmental disabilities, and children in out-of-home care.\n\nAudit records on a routine basis, as well as records for audits (requested on an ad hoc basis) for all lines of business, in order to ensure coding and documentation meet regulatory standards. These may include (but are not limited to) appropriate code usage, appropriate modifier usage, appropriate place of service usage, etc.\n\nCoordinate audit documentation and reports for review for internal and external staff and stakeholders.\n\nIdentify aberrant billing patterns and potential FWA, reporting this to internal staff. Assisting with further investigation and/or reports to state regulators through the utilization of developed critical thinking skills.\n\nAssist with the development and implementation plan for prospective and retrospective FWA avoidance, detection, and referral.\n\nAssist with the creation and submission of regulator deliverables through completion of timely audit activities.\n\nProvide technical assistance and education to providers including training on regulatory requirements, as well as coding and documentation rules.\n\nMaintain compliance with company policies and procedures.\n\nPerform other duties as assigned.\n\nRequired Qualifications\n3-5 years of experience in reviewing and interpreting claims data, as well as medical records and appropriate documentation.\n\n3-5 years of experience with standard industry coding guidelines such as CPT, HCPCs, and ICD-10.\n\nWillingness to work Monday-Friday from 8am-5pm Arizona Time Zone.\n\nMust possess an active CPC (Certified Professional Coder), CCS (Certified Coding Specialist), or CPMA (Certified Professional Medical Auditor) license.\n\nPreferred Qualifications\nPrevious auditing experience.\n\nPrevious Medicaid and/or health plan experience, including AHCCCS (Arizona Health Care Cost Containment System).\n\nPrevious experience with QuickBase.\n\nStrong analytical and critical thinking skills.\n\nStrong attention to detail.\n\nAbility to collaborate and work with a team, as well as work independently as needed.\n\nExcellent presentational skills.\n\nStrong communication skills, both written and verbal.\n\nAbility to be adaptable in a flexible environment.\n\nEducationAssociate’s degree or equivalent experience (2+ years of relevant experience + high school diploma or GED).\nAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $122,400.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. \nOur people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.\nGreat benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.\n\nThis full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments.\n\nWe anticipate the application window for this opening will close on: 07/17/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.\n\nThis job is curated by Lifelancer.Lifelancer is a talent-hiring platform in Life Sciences, Pharma and IT. The platform connects talent with opportunities in pharma, biotech, health sciences, healthtech and IT domains.\nPlease apply via Lifelancer platform to get connected to the application page and to find similar roles.\nOriginally posted on Himalayas","description_format":"text","description_chars":5894,"description_truncated":false,"requirements":{"experience_years_min":null,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":["Wellness"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Health Care","Internet Services","Job Boards & Aggregators","Healthcare Staffing"],"lifecycle":[{"event":"open","at":"2026-10-19T20:28:30Z"}],"visa":[],"liveness":{"score":90,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.9,"p_room":1,"age_days":4,"expected_fill_days":27,"reasons":["seen:4","velocity","win:early","comp:brand"],"computed_at":"2026-10-24T06:02:35Z"},"pay":{"stated_usd_annual":122400,"is_top_pay":true},"html_url":"https://alion.io/job/lifelancer-program-integrity-auditor","json_url":"https://alion.io/job/lifelancer-program-integrity-auditor.json","meta":{"generated_at":"2026-10-24T14:54:39Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":21157,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-25T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":3853997},"rest":"https://alion.io/mcp/rest/get_company?id=3853997"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Flifelancer-program-integrity-auditor"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Flifelancer-program-integrity-auditor"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Flifelancer-program-integrity-auditor"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/lifelancer-program-integrity-auditor\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Flifelancer-program-integrity-auditor"}]}