Integrity Management Services is hiring a
Auditor

Summary

The job is for a Medicaid Auditor at IntegrityM, a women-owned small business specializing in compliance and program integrity efforts. The role involves conducting audits on Medicaid managed care providers to identify fraud, waste, and abuse, and preparing reports summarizing the findings.

Requirements

• Bachelor’s degree in finance, accounting, or related field preferred
• Typically 2+ years of related experience in finance, accounting, or auditing
• Medicaid managed care work experience
• Intermediate understanding of Medicaid managed care
• Intermediate knowledge of internal audit policies and operating principles
• Sufficient writing skills to write a report that clearly identifies any fraud discovered, is easily comprehended, is complete, is thorough, and is accurate and supported by sufficient documentation

Responsibilities

• Perform audits as assigned, which consist of examining all records, accounts, controls, medical billing and fiscal procedures of a Medicaid service provider
• Use audit techniques and procedures to verify the appropriateness of the service provider charges for Medicaid eligible clients/services
• Maintain audit notes and prepare a written report summarizing the conclusions reached during the audit
• Track and monitor of assigned workload to ensure all due dates are met
• Document audit activities and deliverables in external and internal databases
• Prepare exhibits such as analyses, graphs, reports, etc., intended to enhance and clarify any audit, which may be complex and hard to understand
• Perform licensing and exclusion reviews on providers and work with the medical staff to ensure services reimbursed meet regulatory requirements
• Conduct research on relevant State regulatory support for specific States’ and provider types
• Review all applicable State policies and regulations associated to each specific audit assignment or algorithm prior to performing audit
• Understand and maintain the ability to apply regulatory support to the audit findings including ensuring that the citation works for the Provider type being audited
• Attend on-site audits to retrieve medical records and conduct provider entrance/exit conference
• Ensure GAGAS standards are applied to each applicable audit to identify fraud, waste or abuse
• Occasionally go into the field to collect, evaluate, and analyze evidence during an ongoing investigation
• Occasionally be required to assist in an ongoing investigation by conducting field interviews with investigators of providers and/or beneficiaries or patients witnesses

Preferred Qualifications

• CPA, CFE, and/or AHFI certification is a plus
• Used Unified Case Management (UCM) and One PI Business Objects
• Managed large/varied caseloads
• Reviewed medical claims and developing fraud cases
• Applied company policies and procedures in relation to complex investigations
• Reviewed financial records and advise or assist in the investigation of alleged fraud
• Experience with statistical sampling and/or advanced statistical training
• Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data