Medicaid Auditor

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Execute and report on Medicaid Managed Care Plans and providers to uncover potential fraud, waste, and abuse.

• Generate findings and recommendations while identifying improper payments.

• Conduct programmatic or financial audits, including both desk reviews and onsite review activities.

• Undertake case management, program payment evaluations, program and policy compliance, billing, coding, medical record documentation assessments, and industry trend research and analysis.

• Understand and adhere to auditing plans and methodologies specific to contract obligations.

• Prioritize and allocate workload following task order policies and procedures.

• Analyze and compute data from financial documents and statements, including provider cost reports.

• Employ data mining and trend analysis tools to identify anomalies in Medicaid billing and payment patterns.

• Participate in onsite audits, gather medical records, and facilitate provider entrance/exit conferences.

• Prepare and send medical record request letters and determinations for overpayment suspensions.

• Interpret and apply pertinent laws, regulations, policies, and procedures.

• Implement GAGAS standards in applicable audits.

• Draft objective written reports and present findings to leadership, external agencies, and government partners.

• Calculate improper payments and provide findings, recommendations, and corrective actions.

• Liaise with federal/state agencies and providers regarding regulatory compliance, audit findings, and recovery efforts.

• Attend briefings and presentations as needed.

• Uphold fraud case development quality standards and ensure timely updates in investigation tools, databases, and documentation.

• Create and document investigative findings and compile case file documentation.

⛳️ Requirements

• A Bachelor’s Degree in finance, accounting, or a related field is required.

• 5-7 years of relevant experience in finance, accounting, or auditing.

• Intermediate understanding of internal audit policies and operational principles.

• Intermediate knowledge and experience in auditing Medicare/Medicaid and other government payment and oversight programs (CMS, HRSA, OIG, DOE, Dept. of Commerce, etc.).

• Familiarity and experience with government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS).

• Proven investigative skills.

• Strong data analysis capabilities.

• Knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS Level II, and CPT codes, utilizing Medicaid and Contractor guidelines for coverage determinations.

• Experience in reviewing claims for accuracy in billing and medical coding requirements, conducting medical reviews, and/or developing fraud cases.

• Excellent oral and written communication skills, strong interpersonal abilities, and superior organizational skills.

• Capacity to take initiative, maintain confidentiality, meet deadlines, and collaborate in a team environment.

• Ability to report work activities promptly.

• Capability to work independently and as part of a team to deliver high-quality results.

• Skill in multitasking and prioritizing assignments while meeting deadlines.

• Proficient in Microsoft Office, particularly Microsoft Word and Excel.

• A passion for and alignment with IntegrityM’s mission, vision, values, and operational principles.

• Must successfully pass post-hire background screening checks.

• For remote work, access to wired and/or wireless internet is required.

🏝️ Benefits

• Vacation

• Sick leave

• Paid holidays

• Health insurance

• Dental insurance

• Vision insurance

• Short- and long-term disability

• Life insurance

• Employee assistance plan

• 401(K) retirement plan

• Educational benefits