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Certified Medical Audit Specialist III

at Cape Fox

Posted: 4/27/2019
Job Reference #: 4313

Job Description

Cape Fox Facilities Services (CFFS) is seeking a Health Economics Analyst who will research and investigate business issues related to cost, utilization and revenue data.

  • Provides expertise and knowledge of medical record coding requirements applying coding experience to all aspects of DHA compliance review requirements
  • Utilizes specialized medical coding certification (i.e., CPC, COC, CIC, CPMA, etc) when supporting all aspects of medical record review audits
  • Demonstrate a high degree of knowledge of ICD-10, CPT, HCPCS and Medicare coding guidelines
  • Provides technical support and assistance of medical record audits
  • Extrapolates and provides support for healthcare industry policy and coding changes and claims processing requirements
  • Provides expert support with healthcare auditing techniques
  • Provides support and knowledge transfer of specialty medical terminology, anatomy, physiology, and pathophysiology
  • Supports and applies understanding of healthcare data when supporting the development of compliance reviews, focus studies while applying effective data analysis expertise
  • Provides support for improper payments evaluations via the utilization of Microsoft Word, Excel, and Access while applying organizational skills to a project focused work environment that specializes in the TRICARE program and benefits
  • Other duties as assigned by supervisor
0 - 10%
  • Bachelor’s degree in statistics, economics, accounting, finance, health administration, or another related field is required
  • Minimum of five years of experience in related field
  • Experience with TRICARE program and benefits
  • Analytical work experience within the healthcare industry (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
  • Work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis
  • Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting
  • Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue


Cape Fox Corporation, its subsidiaries and affiliates provide equal employment opportunities to all persons and prohibit employment decisions on the basis of race, religion, color, creed, national origin, sex, age, disability, political affiliation, protected veteran status, or sexual orientation. Cape Fox Corporation, its subsidiaries and affiliates offer preference to Cape Fox Corporation shareholders, descendants and other Native Americans pursuant to Public Law 100-241.