Integrity Management Services, Inc. (IntegrityM) is hiring a Medicaid Auditor III to protect the integrity of Medicaid programs. In this full-time, remote role, you will conduct detailed audits of Medicaid Managed Care Plans and providers to identify fraud, waste, abuse, and improper payments, ensuring compliance with complex federal and state regulations.
What You'll Do
- Apply in-depth knowledge of federal and state regulations and healthcare industry standards to audit plans.
- Examine and calculate data from financial documents like provider cost reports.
- Utilize data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns.
- Attend on-site audits to retrieve medical records and conduct provider conferences.
- Prepare and submit medical record request letters to providers.
- Interpret and apply pertinent laws, regulations, policies, and procedures to audit findings.
- Ensure Generally Accepted Government Auditing Standards (GAGAS) are applied to all audits.
- Prepare factual, objective written reports and present findings to leadership and external agencies.
- Calculate improper payments and issue findings, recommendations, and corrective actions.
- Prepare and send overpayment determinations to providers when applicable.
- Communicate with federal/state agencies and providers regarding compliance and recovery.
- Maintain fraud case development quality standards and ensure proper documentation in case databases.
- Develop reports of investigative findings and compile case file documentation.
- Conduct program research and on-site visits or interviews as required.
- Identify weaknesses in audit processes and recommend enhancements for efficiency.
- Ensure compliance with all applicable privacy, security training, and data protection policies.
What We're Looking For
- 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, operating principles, and Medicare/Medicaid programs.
- Experience applying government accounting principles, including GAGAS.
- Experienced investigative and strong data analysis skills.
- Knowledge of medical terminology, ICD-9-CM, ICD-10-CM, HCPCS Level II, and CPT codes.
- Experience reviewing claims for appropriate billing and medical coding, performing medical review, or developing fraud cases.
- Strong oral/written communication, interpersonal, and superior organizational abilities.
- Ability to take initiative, maintain confidentiality, meet deadlines, and work collaboratively.
- Ability to work independently and as a team member to deliver high-quality work.
- Ability to multitask and prioritize assignments while meeting deadlines.
- Proficiency in Microsoft Office, specifically Word and Excel.
- Passion and alignment with IntegrityM’s mission, vision, values, and operating principles.
- Must pass post-hire background screening checks.
- For remote work, required to have wired and/or wireless internet access.
Technical Stack
- Microsoft Office
- Microsoft Word
- Microsoft Excel
Team & Environment
You will work independently as well as collaboratively with other audit staff in a dynamic, idea-driven environment that nurtures professional development.
Work Mode
This is a full-time, remote position.
IntegrityM is an equal opportunity employer.
