Medicaid Audit Team Lead

At Commence were the start of a new age of data-centric transformation elevating health outcomes and powering better more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers technology that advances performance and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered healthcare-relevant and value-based solutions we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose straightforward communication and clinical domain expertise Commence cuts straight to better care.

The Audit Case Team Lead manages the comprehensive audit function overseeing provider and member audits from case initiation through final disposition and recovery. This position requires strong audit methodology expertise team leadership skills and the ability to manage complex investigations with significant financial implications. The Team Lead works closely with the State to ensure audit quality compliance and effective overpayment recovery.

• Lead audit team in conducting comprehensive provider and member audits
• Develop audit plans methodologies and sampling strategies
• Review and approve audit findings and overpayment calculations
• Prepare audit recommendations for State review and approval
• Coordinate with clinical staff on medical necessity determinations
• Manage case progression from preliminary investigation through final disposition
• Ensure audit documentation meets State and federal standards
• Supervise audit analysts and provide training and mentorship
• Interface with providers regarding audit findings and appeals
• Track audit performance metrics and recovery rates
• Participate in quarterly business planning and fraud trend analysis
• Attend bi-weekly status meetings and provide audit updates to State

Qualifications

• Bachelors degree in Accounting Finance Healthcare Administration or related field
• Professional certifications required: CPA CFE CIA or CHC
• Multiple certifications preferred
• Minimum 5 years of healthcare audit experience preferably in Medicaid program integrity
• Minimum 3 years of supervisory or team lead experience
• Proven track record of identifying and quantifying healthcare fraud and overpayments
• Experience with medical record review and clinical documentation analysis
• Demonstrated success managing complex multi-provider audits

Knowledge and Skills

• Expert knowledge of audit methodologies and sampling techniques
• Deep understanding of Medicaid billing rules and documentation requirements
• Proficiency with medical coding systems (CPT HCPCS ICD-10)
• Knowledge of fraud schemes and abuse patterns by provider type
• Strong analytical and investigative skills
• Excellent written and verbal communication abilities
• Proficiency with data analytics tools and case management systems
• Leadership and team development capabilities

Other Requirements

• Full-time dedication to Indiana contract
• Available for in-person meetings at State offices as required
• Successfully pass background check
• Subject to State approval

is committed to providing equal employment opportunities to all applicants including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability please contact Human Resources at or Please note that unless you are requesting accommodation all applications must be submitted through our online application system.