LogoFresh Jobs Ahead
Integrity Management Services, Inc.
Integrity Management Services, Inc.
51 – 200 Xodimlar
KonsaltingSog‘liqni saqlashSug‘urta

Integrity Management Services, Inc. (IntegrityM) davlat idoralari, sog‘liqni saqlash va sug‘urta tashkilotlari, tijorat korxonalari hamda davlat sektoridagi boshqa hamkorlarga xizmat ko‘rsatuvchi ayollarga tegishli konsalting kompaniyasidir. Kompaniya faoliyati noto‘g‘ri to‘lovlar, firibgarlik, isrofgarchilik va suiiste’molni kamaytirish, shu bilan birga muvofiqlik, shaffoflik va dasturlar ustidan nazoratni kuchaytirishga qaratilgan.

Kompaniya ma’lumotlar tahlilini firibgarlik bo‘yicha tekshiruvlar, auditlar, muvofiqlikni ko‘rib chiqish, grantlarni boshqarish, xodimlar bilan ta’minlash, shuningdek kodlash va tibbiy ko‘rib chiqish xizmatlari bilan birlashtiradi. IntegrityM dastur samaradorligi haqida aniqroq tushuncha, kuchliroq nazorat vositalari va yanada asoslangan operatsion qarorlarga muhtoj federal va shtat idoralari, shuningdek xususiy sektor tashkilotlarini qo‘llab-quvvatlaydi.

LinkedIn
Kompaniyadagi ish o‘rinlari

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.

USAmerika Qo‘shma ShtatlariVAVirjiniya
55 000 $ – 75 000 $ / yil
MasofaviyTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaAuditor

Tavsif

  • 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.

Talablar

  • 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.

Imtiyozlar

  • 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

O‘xshash ish o‘rinlari

BlueCross BlueShield of South Carolina

Auditor II, Medicare Cost Reporting

BlueCross BlueShield of South Carolina
HuquqKonsaltingSog‘liqni saqlash
USAmerika Qo‘shma ShtatlariALAlabamaAKAlyaskaAZArizonaCAKaliforniyaCOKoloradoCTKonnektikutFLFloridaHIGavayiIDAydahoILIllinoysIAAyovaKSKanzasKYKentukkiLALuizianaMEMenMDMerilendMAMassachusetsMIMichiganMNMinnesotaMSMissisipiMOMissuriMTMontanaNENebraskaNVNevadaNHNyu-HempshirNJNyu-JersiNMNyu-MeksikoNYNyu-YorkNCShimoliy KarolinaNDShimoliy DakotaOHOgayoOKOklaxomaOROregonPAPensilvaniyaRIRod-AylendSCJanubiy KarolinaSDJanubiy DakotaTNTennessiTXTexasUTYutaVTVermontVAVirjiniyaWAVashingtonWIViskonsinWYVayoming
49 447 $ – 94 737 $ / yil
MasofaviyTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaAuditor

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.

Ochish
Cotiviti

Senior Appeals Auditor – Cotiviti (Remote, US)

Cotiviti
5 001 – 10 000 Xodimlar
H1B vizasi homiysiKonsaltingLogistikaSog‘liqni saqlash
USAmerika Qo‘shma Shtatlari
47 $ – 57 $ / soat
MasofaviyTo‘liq stavkaSeniorTalab Qilinadigan Til: inglizchaAuditor

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.

Ochish