Medicaid Auditor (Full-time, Remote)

Integrity Management Services•Alexandria, VA

7d•Remote

About The Position

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business supporting government and commercial clients with compliance and program integrity efforts, including preventing and detecting fraud, waste, and abuse in government programs. The company uses data analytics, technology solutions, audits, investigations, and medical reviews. IntegrityM describes its workplace as flexible, collaborative, and supportive of employee development and community involvement. The Medicaid Auditor performs and reports on reviews of Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse, issue findings and recommendations, and identify improper payments. Assignments may be programmatic or financial and may include desk reviews and/or onsite activities, as determined by federal and state regulations. Review types may include case management, program payment appropriateness, program and policy compliance, billing, coding, medical record documentation, and research and analysis of industry trends. The auditor works independently and collaboratively with other audit staff. This is a full-time remote position. The U.S. remote annual salary range is $55,000–$75,000. Final pay may vary based on work location and job-related factors, and may fall outside the stated range. Remote employees must have wired and/or wireless internet access. Candidates must pass post-hire background screening checks.

Requirements

Bachelor’s degree in a related field.
2–5 years of related experience in finance, accounting, or auditing.
Knowledge and experience auditing Medicare/Medicaid and other government payment and oversight programs, including CMS, HRSA, OIG, DOE, and the Department of Commerce.
Knowledge and experience applying government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS).
Investigative skills and 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 and interpersonal skills, and superior organizational abilities.
Ability to take initiative, maintain confidentiality, meet deadlines, work in a team environment, and report work activity on a timely basis.
Ability to work independently and collaboratively to deliver high-quality work, and to multitask and prioritize assignments while meeting deadlines.
Proficiency in Microsoft Office, particularly Microsoft 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

Apply in-depth knowledge of federal and state regulations and healthcare industry standards.
Examine and calculate data from financial documents and statements, such as provider cost reports, as part of audits.
Use data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns.
Prepare and submit medical record request letters to providers in connection with requests for medical records or suspension overpayment determinations.
Interpret and apply relevant laws, regulations, policies, and procedures to audit findings.
Prepare factual, objective written reports in accordance with professional auditing and evaluation standards, and present findings to leadership, external agencies, and government partners.
Communicate with federal and state agencies and providers about regulatory compliance, audit findings, and the recovery process.
Attend briefings and presentations as assigned.
Maintain proper and timely updates in appropriate investigation tools and applications.
Develop case databases and documents.