Medicaid Auditor (Full-time, Remote)

Integrity Management Services, Inc.•Alexandria, VA

8d•$55,000 - $75,000•Remote

About The Position

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business that helps 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 review. IntegrityM describes its workplace as flexible and collaborative, with an emphasis on community support, sustainability, creative solutions, and employee professional development. The Medicaid Auditor performs and reports on Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse, issue findings and recommendations, and identify improper payments. Audit assignments may be programmatic or financial and can include desk reviews and/or onsite reviews 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. The role requires a related bachelor’s degree and 2–5 years of related finance, accounting, or auditing experience. Applicants should have experience with government payment and oversight programs, government accounting principles and standards, investigative work, data analysis, medical terminology and coding, and claims review. This is a remote role with a stated annual salary range of $55,000–$75,000. The position is eligible for benefits applicable to full-time regular employees. A post-hire background screening is required, and remote employees must have wired and/or wireless internet access.

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, or the Department of Commerce.
Knowledge and experience applying government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS).
Investigative skills.
Strong data-analysis skills.
Knowledge of medical terminology, 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 as part of a team 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

Apply in-depth knowledge of federal and state regulations and healthcare industry standards.
Examine and calculate data from financial documents and statements, including 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 medical-record requests or suspension overpayment determinations.
Interpret and apply relevant laws, regulations, policies, and procedures to specific 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 timely and accurate updates in applicable tools and applications for investigations, case-development databases, and documents.