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Integrity Management Services, Inc.
Integrity Management Services, Inc.
51 – 200 Darbinieki
ApdrošināšanaKonsultācijasVeselības aprūpe

Integrity Management Services, Inc. (IntegrityM) ir sieviešu sieviešu īpašumā esošs konsultāciju uzņēmums, kas apkalpo valsts iestādes, veselības aprūpes un apdrošināšanas organizācijas, komercuzņēmumus un citus publiskā sektora partnerus. Uzņēmuma darbība ir vērsta uz nepamatotu maksājumu, krāpšanas, izšķērdēšanas un ļaunprātīgas izmantošanas mazināšanu, vienlaikus stiprinot atbilstību, pārredzamību un programmu uzraudzību.

Uzņēmums apvieno datu analīzi ar krāpšanas izmeklēšanu, revīzijām, atbilstības pārbaudēm, dotāciju pārvaldību, personāla kapacitātes papildināšanu, kā arī kodēšanas un medicīniskajām pārbaudēm. IntegrityM atbalsta federālās un štatu iestādes, kā arī privātā sektora organizācijas, kurām nepieciešams skaidrāks priekšstats par programmu darbību, stingrāki kontroles mehānismi un labāk informēti operatīvie lēmumi.

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Vakances uzņēmumā

Medicaid Auditor

Audit Medicaid managed care plans and providers for Integrity Management Services, a government compliance and program integrity firm. Identify fraud, waste, abuse, and improper payments.

USAmerikas Savienotās ValstisVAVirdžīnija
55 000 $ – 75 000 $ / gads
AttālinātiPilna slodzeVidējais līmenisVecākais speciālistsNepieciešamā Valoda: angļuRevidents

Apraksts

  • Audit Medicaid managed care plans and providers, reporting potential fraud, waste, and abuse.
  • Document findings and recommend actions while identifying improper payments.
  • Conduct financial and program audits through desk reviews and onsite work.
  • Review case management, payment appropriateness, program and policy compliance, billing, coding, medical records, and industry trends.
  • Follow audit plans and methods set by contract requirements.
  • Prioritize and assign work in line with task order policies and procedures.
  • Examine and calculate figures from financial records and statements, including provider cost reports.
  • Use data mining and trend analysis to identify unusual Medicaid billing and payment patterns.
  • Attend onsite audits, obtain medical records, and lead provider opening and closing conferences.
  • Prepare and submit medical record requests and overpayment suspension determinations.
  • Interpret and apply relevant laws, regulations, policies, and procedures.
  • Apply GAGAS standards to audits where applicable.
  • Write objective reports and present findings to leaders, external agencies, and government partners.
  • Calculate improper payments and issue findings, recommendations, and corrective actions.
  • Liaise with federal and state agencies and providers on regulatory compliance, audit findings, and recovery.
  • Take part in briefings and presentations.
  • Maintain quality standards for fraud case development and keep investigation tools, databases, and documents updated on time.
  • Develop and record investigative findings and assemble case file documentation.

Prasības

  • Bachelor’s degree in finance, accounting, or a related field.
  • Five to seven years of relevant finance, accounting, or auditing experience.
  • Intermediate understanding of internal audit policies and operating principles.
  • Intermediate knowledge and experience auditing Medicare, Medicaid, and other government payment and oversight programs, such as CMS, HRSA, OIG, DOE, and the Department of Commerce.
  • Knowledge and experience applying government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS).
  • Investigative experience.
  • Strong data analysis skills.
  • Knowledge of medical terminology and ICD-9-CM, ICD-10-CM, HCPCS Level II, and CPT codes; ability to use Medicaid and contractor guidelines for coverage determinations.
  • Experience reviewing claims for billing and coding compliance, conducting medical reviews, and/or developing fraud cases.
  • Strong verbal and written communication, interpersonal, and organizational skills.
  • Ability to take initiative, protect confidential information, meet deadlines, and work collaboratively.
  • Ability to report work activity promptly.
  • Ability to work independently and collaboratively to deliver high-quality work.
  • Ability to manage multiple assignments, set priorities, and meet deadlines.
  • Proficiency with Microsoft Office, especially Word and Excel.
  • Commitment to IntegrityM’s mission, vision, values, and operating principles.
  • Must pass post-hire background screening.
  • Remote work requires wired and/or wireless internet access.

Priekšrocības

  • Vacation leave
  • Sick leave
  • Paid holidays
  • Health insurance
  • Dental insurance
  • Vision insurance
  • Short- and long-term disability coverage
  • Life insurance
  • Employee assistance plan
  • 401(k) retirement plan
  • Educational benefits

Saistītās vakances

BlueCross BlueShield of South Carolina

Auditor II, Medicare Cost Reporting

BlueCross BlueShield of South Carolina
Juridiskie pakalpojumiKonsultācijasVeselības aprūpe
USAmerikas Savienotās ValstisALAlabamaAKAļaskaAZArizonaCAKalifornijaCOKolorādoCTKonektikutaFLFloridaHIHavajasIDAidahoILIlinoisaIAAiovaKSKanzasaKYKentukiLALuiziānaMEMeinaMDMerilendaMAMasačūsetsaMIMičiganaMNMinesotaMSMisisipiMOMisūriMTMontānaNENebraskaNVNevadaNHŅūhempšīraNJŅūdžersijaNMŅūmeksikaNYŅujorkaNCZiemeļkarolīnaNDZiemeļdakotaOHOhaioOKOklahomaOROregonaPAPensilvānijaRIRodailendaSCDienvidkarolīnaSDDienviddakotaTNTenesīTXTeksasaUTJūtaVTVērmontaVAVirdžīnijaWAVašingtonaWIViskonsinaWYVaiominga
49 447 $ – 94 737 $ / gads
AttālinātiPilna slodzeVidējais līmenisVecākais speciālistsNepieciešamā Valoda: angļuRevidents

Conducts financial, compliance, and operational audits for BlueCross Blue Shield of South Carolina, with a focus on Medicare cost reports. Evaluates controls and business risks, recommends corrective actions, and supports remote audits across the United States.

Atvērt
Cotiviti

Senior Appeals Auditor – Cotiviti (Remote, US)

Cotiviti
5001 – 10 000 Darbinieki
H1B vīzas sponsorsKonsultācijasLoģistikaVeselības aprūpe
USAmerikas Savienotās Valstis
47 $ – 57 $ / stunda
AttālinātiPilna slodzeVecākais speciālistsNepieciešamā Valoda: angļuRevidents

Defend Cotiviti’s recovery decisions by reviewing Medicare claims, clinical records, coding, medical necessity, and provider appeals. Prepare evidence-based appeal responses and support cases progressing to Administrative Law Judge hearings.

Atvērt