Medicaid Auditor (Full-time, Remote)

Integrity Management Services, Inc.•Alexandria, VA

1d•$55,000 - $75,000•Remote

About The Position

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business that supports government and commercial clients with compliance and program integrity, including preventing and detecting fraud, waste, and abuse. Its work includes data analytics, technology solutions, audits, investigations, and medical reviews. The company describes its workplace as flexible, collaborative, and focused on opportunity, recognition, community support, sustainability, and employee professional development. The Medicaid Auditor performs and reports on audits of Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse, improper payments, and opportunities for corrective action. Assignments may be programmatic or financial and may involve desk reviews or onsite activities, depending on federal and state regulations. Review areas may include case management, payment appropriateness, program and policy compliance, billing, coding, medical record documentation, and research and analysis of industry trends. The role applies audit methodologies and relevant laws, regulations, policies, and procedures; analyzes financial and claims information; develops investigative cases and reports; calculates improper payments; and communicates findings and recommendations to leadership, agencies, government partners, and providers. The position is remote and requires wired and/or wireless internet access. It requires a bachelor’s degree in finance, accounting, or a related field and 5–7 years of related finance, accounting, or auditing experience. The U.S. remote annual salary range is $55,000–$75,000. The position is eligible for benefits applicable to full-time regular employees.

Requirements

Bachelor’s degree in finance, accounting, or a related field.
5–7 years of related experience in finance, accounting, or auditing.
Intermediate knowledge of internal audit policies and operating principles.
Intermediate knowledge and experience auditing Medicare/Medicaid and other government payment and oversight programs, such as CMS, HRSA, OIG, DOE, and the Department of Commerce.
Knowledge and experience applying government accounting principles and standards, including GAGAS.
Investigative skills.
Strong data-analysis skills.
Knowledge of medical terminology and ICD-9-CM, ICD-10-CM, HCPCS Level II, and CPT codes; ability to use Medicaid and contractor guidelines for coverage determinations.
Experience reviewing claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases.
Strong oral and written communication, interpersonal, and organizational skills.
Ability to take initiative, maintain confidentiality, meet deadlines, and work in a team environment.
Ability to report work activity on a timely basis.
Ability to work independently and collaboratively to deliver high-quality work.
Ability to multitask and prioritize assignments while meeting deadlines.
Proficiency in Microsoft Office, specifically Word and Excel.
Passion for and alignment with IntegrityM’s mission, vision, values, and operating principles.
Must pass post-hire background screening checks.
For remote work, must have wired and/or wireless internet access.

Responsibilities

Follow audit plans and methodologies specific to contract requirements.
Prioritize and assign workload while ensuring adherence to task order policies and procedures.
Examine and calculate data from financial documents and statements, including provider cost reports.
Use data-mining and trend-analysis tools to detect anomalies in Medicaid billing and payment patterns.
Attend onsite audits to retrieve medical records and conduct provider entrance and exit conferences.
Prepare and submit medical record request letters to providers in connection with record requests or suspension overpayment determinations.
Interpret and apply relevant laws, regulations, policies, and procedures to audit findings and the provider type being audited.
Apply Generally Accepted Government Auditing Standards (GAGAS) to applicable audits to identify fraud, waste, or abuse.
Prepare factual, objective written reports in accordance with professional auditing and evaluation standards, and present findings to leadership, external agencies, and government partners.
Calculate improper payments and issue findings, recommendations, and corrective actions in accordance with applicable requirements.
Prepare and send suspension overpayment determinations to providers when applicable.
Communicate with federal and state agencies and providers about regulatory compliance, audit findings, and the recovery process.
Attend briefings and presentations as assigned.
Maintain fraud case development quality standards and ensure cases are properly developed and prepared.
Maintain timely and accurate updates in investigation tools, applications, case-development databases, and documents.
Develop and document investigative findings, compile case-file documentation, calculate improper payments, and issue findings, recommendations, and corrective actions.