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Medicaid Audit and Compliance Specialist (Full-time, Remote)

1 week, 5 days ago
United States
Full-time
Senior
Accountant
Operations
Apply Now
IntegrityM

IntegrityM

Integrity Management Services Offers a large variety of data integrity solutions including audits, fraud investigations, medical reviews, and more. Certified #WOSB providing expertise in #analytics, #audits #investigations #compliance #medicalreview #s...

Professional Services
51-250
Founded 2009
View All Jobs 6

Description

  • Perform Medicaid audits and reviews of managed care plans and providers to identify fraud, waste, abuse, and improper payments.
  • Apply federal and state regulations, healthcare industry standards, and GAGAS to audit work and findings.
  • Review programmatic and financial documentation, including cost reports, medical records, billing, coding, and case management materials.
  • Use data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns.
  • Conduct on-site audits, retrieve records, and participate in provider entrance and exit conferences.
  • Prepare medical record request letters, suspension overpayment determinations, and other audit correspondence.
  • Calculate improper payments and develop factual, objective reports with findings, recommendations, and corrective actions.
  • Communicate audit results and compliance issues with providers, federal/state agencies, leadership, and government partners.
  • Maintain accurate case development records, investigative documentation, and timely updates in case management tools.
  • Identify process weaknesses and recommend improvements to audit efficiency and effectiveness.

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.
  • Knowledge of government accounting principles and Generally Accepted Government Auditing Standards (GAGAS).
  • Experience with investigative work 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 requirements, performing medical review, or developing fraud cases.
  • Strong oral and written communication skills, interpersonal skills, and organizational abilities.
  • Proficiency in Microsoft Word and Excel.
  • Ability to maintain confidentiality, meet deadlines, multitask, prioritize assignments, and work independently and on a team.
  • Must pass post-hire background screening checks.
  • Must have wired and/or wireless internet access for remote work.
  • Experience with Medicaid and contractor guidelines for coverage determinations is required.
  • Passion and alignment with IntegrityM’s mission, vision, values, and operating principles.

Interested in this position?

Apply directly on the company website

Apply Now

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