FWA Program Auditor I (2026-49761)

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When you join the UMass Chan Medical School team, you join us in advancing together to improve the health and well-being of our diverse communities throughout Massachusetts and across the US and the world. Together, we lead in education, research, health care delivery, and public service. Your life's work is more than a career. It's an expression of your passion, intellect, skill, and drive. UMass Chan"s commitment to excellence, innovation, competitive benefits, and work-life integration will allow you to build a professionally rewarding career as we work together to better or improve the health of people around the globe.

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FWA Program Auditor I

Job Number: 2026-49761

Category: Administrative Professional

Location: Westborough, MA

Shift: Day

Exempt/Non-Exempt: Exempt

Business Unit: ForHealth Consulting

Department: ForHealth Consulting - Health Care Finance Solutions - Financial Compliance - W407618

Job Type: Full-Time

Num. Openings: 3

Post Date: May 1, 2026

Work Location: Hybrid

Salary Minimum: USD $80,000.00/Yr.

Salary Maximum: USD $95,000.00/Yr.

Under the general direction of the Associate Director or designee, the Fraud, Waste, and Abuse (FWA) Auditor serves a crucial role in identifying, investigating, and preventing fraud, waste and abuse for Medicaid programs. A major function of this position is to conduct desk and onsite audits across various provider types to ensure compliance with federal and state regulations. The Auditor performs investigative activities to develop leads and detect aberrant billing practices, including data mining, claims analysis, and medical record assessment.

Responsibilities:

• Ensure compliance with federal and state regulations and healthcare FWA industry standards.
• Perform independent data mining and data analysis utilizing claims data to detect patterns and trends that may uncover fraud, waste, or non-compliant billing practices.
• Conduct onsite audits as required, to assess the completeness of medical and administrative records and the compliance with applicable regulatory requirements.
• Prepare detailed audit documentation, summaries of investigative findings, compile case files, calculate sanctions and overpayments based on violations cited.
• Communicate with providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.
• Recommend policy, procedure and system changes to enhance investigative outcomes.
• Update appropriate internal management staff regularly on progress of investigations.
• Stay current with regulatory updates, coding changes, and industry standards.
• Identify trends from national fraud-related publications and recommend new or improved strategies to strengthen fraud-detection efforts.
• Assist with document management, updating case-tracking system and adhering to record retention policies and procedures.
• Perform other duties as assigned.

Qualifications:

• Bachelor"s degree in business, health care administration, or other related field
• 4-6 years of related experience in the healthcare industry, business,; with at least two years of experience conducting data mining in the healthcare insurance industry, healthcare claim audits, administrative medical record reviews or other claims analysis related experience
• Knowledge of CPT, HCPCS and ICD-10 coding, reimbursement and claims processing policies
• Strong analytical and qualitative skills as well as problem solving skills with the ability to look for root causes and implement workable solutions
• Ability to interpret and apply law and regulations as it relates to fraud and fraud investigations
• Ability to multi-task, establish priorities and work independently and collaboratively to achieve audit objectives
• Proficiency in Microsoft Office applications (Word, Excel, PowerPoint and Access)
• Excellent Customer service skills with the ability to interact professionally and effectively with providers, clients, and internal stakeholders from all departments
• Ability to travel within Massachusetts and be on-site as needed for audits

Preferred Qualifications:

Prefer individual possessing any of the following certifications or licensure: CPC or CPMA

Knowledge of state and federal regulations as they apply to public assistance programs

Posting Disclaimer:

This job posting outlines the primary responsibilities and qualifications for the role but is not intended to be an exhaustive list. Duties and expectations may evolve in response to the needs of the department and the broader institution.

In alignment with our commitment to pay transparency, the base salary range for this position is listed above (exclusive of benefits and retirement). At UMass Chan Medical School, final base salary offers are determined based on a combination of factors, including your skills, education, and relevant experience. We also consider internal equity to ensure fair and consistent compensation across our teams.

Please note that the range provided reflects the full base salary range for this position. Offers are typically made within the midrange to allow for future growth and development within the role.

In addition to base pay, UMass Chan offers a comprehensive Total Rewards package, which includes paid time off, medical, dental, and vision coverage, and participation in a 401(a)-retirement plan, with the option to contribute to a voluntary 403(b) plan.

UMass Chan welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.

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