Medicaid Auditor

Integrity Management Services, Inc.

. Perform and report on Medicaid Managed Care Plans and Providers to identify potential fraud, waste, and abuse.

Posted 10/27/2026full-timeAlexandria • Virginia • United StatesJuniorMid-Level💰 $55,000 - $75,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing Medicaid Managed Care Plans and Providers, applying federal and state regulations, and conducting financial audits. Proficient in data analysis, medical coding, and compliance with government accounting standards.

Highest-signal resume keywords

Medicaid AuditingData AnalysisGovernment Accounting PrinciplesMedical Coding KnowledgeStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Financial AuditingData MiningTrend AnalysisMedical Record DocumentationBilling and Coding ReviewInvestigative SkillsICD-9-CMICD-10-CMHCPCS Level IICPT Codes

Soft Skills

Interpersonal SkillsOrganizational AbilitiesInitiativeConfidentialityMultitasking

Tools & Technologies

Microsoft OfficeMicrosoft WordMicrosoft ExcelInvestigation ToolsCase Development Databases

Industry Keywords

MedicaidFraud DetectionWaste and AbuseGovernment Payment ProgramsGenerally Accepted Government Auditing Standards (GAGAS)

About the role

Key responsibilities & impact

Perform and report on Medicaid Managed Care Plans and Providers to identify potential fraud, waste, and abuse.
Issue audit findings and recommendations and identify improper payments.
Conduct programmatic or financial audits, including desk reviews and/or onsite review activities.
Review case management, program payment appropriateness, program and policy compliance, billing, coding, medical record documentation, and industry trends.
Apply federal and state regulations and healthcare industry standards.
Examine and calculate data from financial documents and statements, including provider cost reports.
Use data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns.
Prepare and submit medical record request letters to providers.
Interpret and apply laws, regulations, policies, and procedures to audit findings.
Prepare factual, objective written reports according to professional auditing and evaluation standards.
Present findings to leadership, external agencies, and government partners.
Communicate with federal/state agencies and providers regarding regulatory compliance, audit findings, and recovery.
Attend assigned briefings and presentations.
Maintain timely updates in investigation tools, case development databases, and documents.
Work independently and collaboratively with other audit staff.

Requirements

What you’ll need

Bachelor’s Degree in related field required.
2-5 Years of related experience in finance, accounting, or auditing.
Knowledge and experience in auditing Medicare/Medicaid and other government payment and oversight programs.
Knowledge and experience in the application of government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS).
Experienced investigative skills.
Strong data analysis skills.
Knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS level II and CPT codes.
Experience in reviewing claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases.
Strong oral and written communication skills, strong interpersonal skills, and superior organizational abilities.
Ability to take initiative, maintain confidentiality, meet deadlines, and work in a team environment.
Ability to report work activity on a timely basis.
Ability to work independently and as a member of a team to deliver high quality work.
Ability to multitask and prioritize assignments while meeting deadlines.
Proficiency in Microsoft Office, specifically Microsoft Word and Excel.
Passion and alignment with IntegrityM’s mission, vision, values and operating principles.
Must pass post hire background screening checks.
For remote work, required to have wired and/or wireless internet access.

Benefits

Comp & perks

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
Wired and/or wireless internet access required for remote work