[Hiring] Medicaid Audit and Compliance Specialist @Integrity Management Services, Inc.

Role Description

In this role, the Medicaid Audit and Compliance Specialist will be responsible for performing and reporting on Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse; issue findings and recommendations; and identify improper payments. Audit assignments can be programmatic or financial and may range from desk reviews and/or onsite review activities as determined by federal and state regulations. Specific review types may include:

• Case management
• Program payment appropriateness
• Program and policy compliance
• Billing, coding, and medical record documentation reviews
• Research and analysis of industry trends

The Medicaid Audit and Compliance Specialist will perform audits as assigned, which consist of but are not limited to:

• Performing licensing and exclusion reviews on providers
• Working with the medical staff to ensure services are reimbursed in accordance with regulatory requirements
• Working independently as well as collaboratively with other audit staff

Qualifications

• Bachelor’s Degree in finance, accounting or related field required
• 5-7 Years of related experience in finance, accounting, or auditing
• Intermediate knowledge of internal audit policies and operating principles
• Intermediate knowledge and experience in auditing Medicare/Medicaid and other government payment and oversight programs (CMS, HRSA, OIG, DOE, Dept. of Commerce etc.)
• Knowledge and experience in the application of government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS)
• Experienced investigative skills
• Strong data analysis skills
• Knowledge of medical terminology, ICD-9-CM, ICD-10-CM, HCPCS level II, and CPT codes
• Experience in reviewing claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases
• Strong oral and written communication skills
• Strong interpersonal skills and superior organizational abilities
• 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 a member of a team to deliver high quality work
• Ability to multitask and prioritize assignments while meeting deadlines
• Proficiency in Microsoft Office, specifically Microsoft Word and Excel
• Passion and alignment with IntegrityM’s mission, vision, values and operating principles

Requirements

• Must pass post hire background screening checks
• For remote work, required to have wired and/or wireless internet access

Company Description

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.

At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development.

Large company perks…Small company feel!