Senior Medical Audit Specialist

Job Posting Title Senior Medical Audit Specialist Agency 807 HEALTH CARE AUTHORITY Supervisory Organization Program Integrity & Account Job Posting End Date Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Note:

Applications will be accepted until 11:59 PM on the day prior to the posting end date above. Estimated Appointment End Date (Continuous if Blank) Full/Part-Time Full time Job Type Regular Compensation $78,465.00/annual

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. Learn more about OHCA.

• 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

Location:

4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $78,465.00/annual

Work Schedule:

Monday – Friday Primary

Hours:

8:00 a.m. – 5:00 p.m.

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. As part of the interview process, candidates may be required to attend an in‑person interview at our Oklahoma City office.

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.

• 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
• Other duties as assigned

This position does not supervise.

The Senior…