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Integrity Management Services, Inc.
Integrity Management Services, Inc.
51 – 200 Angajați
AsigurăriAsistență medicalăConsultanță

Integrity Management Services, Inc. (IntegrityM) este o companie de consultanță deținută de femei, care deservește agenții guvernamentale, organizații din domeniul sănătății și asigurărilor, întreprinderi comerciale și alți parteneri din sectorul public. Activitatea sa se concentrează pe reducerea plăților necorespunzătoare, a fraudei, risipei și abuzului, consolidând în același timp conformitatea, transparența și supravegherea programelor.

Compania combină analiza datelor cu investigații privind frauda, audituri, evaluări de conformitate, gestionarea granturilor, suplimentarea personalului și verificări de codificare și medicale. IntegrityM sprijină agenții federale și de stat, precum și organizații din sectorul privat care au nevoie de o perspectivă mai clară asupra performanței programelor, de controale mai solide și de decizii operaționale mai bine fundamentate.

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Locurile de muncă ale companiei

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.

USStatele Unite ale AmericiiVAVirginia
55.000 $ – 75.000 $ / an
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăAuditor

Descriere

  • 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.

Cerințe

  • 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.

Beneficii

  • 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

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USStatele Unite ale AmericiiALAlabamaAKAlaskaAZArizonaCACaliforniaCOColoradoCTConnecticutFLFloridaHIHawaiiIDIdahoILIllinoisIAIowaKSKansasKYKentuckyLALouisianaMEMaineMDMarylandMAMassachusettsMIMichiganMNMinnesotaMSMississippiMOMissouriMTMontanaNENebraskaNVNevadaNHNew HampshireNJNew JerseyNMNew MexicoNYNew YorkNCCarolina de NordNDDakota de NordOHOhioOKOklahomaOROregonPAPennsylvaniaRIRhode IslandSCCarolina de SudSDDakota de SudTNTennesseeTXTexasUTUtahVTVermontVAVirginiaWAWashingtonWIWisconsinWYWyoming
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