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

1 hour, 29 minutes 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 programmatic and financial audits of Medicaid Managed Care Plans and providers through desk reviews and onsite review activities.
  • Identify potential fraud, waste, abuse, and improper payments, and issue findings, recommendations, and corrective actions.
  • Review case management, payment appropriateness, program and policy compliance, billing, coding, and medical record documentation.
  • Apply federal and state regulations, healthcare industry standards, and GAGAS to audit work.
  • Examine and calculate data from financial documents such as provider cost reports.
  • Use data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns.
  • Attend onsite audits to retrieve medical records, conduct provider entrance and exit conferences, and perform interviews as needed.
  • Prepare medical record request letters, suspension overpayment determinations, and factual written reports.
  • Communicate audit findings and recovery processes with federal/state agencies, providers, leadership, and external partners.
  • Maintain case development quality standards, update investigation tools and databases, and identify process improvements.

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 standards, including 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, strong interpersonal skills, and superior organizational abilities.
  • Proficiency in Microsoft Word and Excel; must pass post-hire background screening and have wired and/or wireless internet access for remote work.

Benefits

  • Flexible, small-workplace environment with a strong quality-of-life focus.
  • Culture of opportunity, recognition, collaboration, and community support.
  • Support for employee professional development in an idea-driven environment.
  • Large-company perks with a small-company feel.

Interested in this position?

Apply directly on the company website

Apply Now

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