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Integrity Management Services, Inc.Posted 10/22/2026full-timeRemote • Virginia • United StatesMid-LevelSenior💰 $55,000 - $75,000 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in auditing Medicaid Managed Care Plans, including financial audits, compliance assessments, and fraud detection. Proficient in data analysis, medical coding, and applying government accounting standards to ensure regulatory adherence.
Highest-signal resume keywords
Medicaid AuditingData AnalysisGAGAS StandardsMedical CodingFinancial Audits
About the role
Key responsibilities & impact- Perform and report on Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse.
- Issue findings and recommendations and identify improper payments.
- Conduct programmatic or financial audits, including desk reviews and onsite review activities.
- Perform case management, program payment appropriateness, program and policy compliance, billing, coding, medical record documentation reviews, and industry trend research and analysis.
- Comprehend and follow auditing plans and methodologies specific to contract requirements.
- Prioritize and assign workload while adhering to task order policies and procedures.
- 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.
- Attend onsite audits, retrieve medical records, and conduct provider entrance/exit conferences.
- Prepare and submit medical record request letters and suspension overpayment determinations.
- Interpret and apply relevant laws, regulations, policies, and procedures.
- Apply GAGAS standards to applicable audits.
- Prepare objective written reports and present findings to leadership, external agencies, and government partners.
- Calculate improper payments and issue findings, recommendations, and corrective actions.
- Communicate with federal/state agencies and providers regarding regulatory compliance, audit findings, and recovery.
- Attend briefings and presentations.
- Maintain fraud case development quality standards and timely updates in investigation tools, databases, and documents.
- Develop and document investigative findings and compile case file documentation.
Requirements
What you’ll need- Bachelor’s Degree in finance, accounting or related field required.
- 5-7 Years of related experience in finance, accounting, or auditing.
- Intermediate knowledge of internal audit policies and operating principles.
- Intermediate knowledge and experience in auditing Medicare/Medicaid and other government payment and oversight programs. (CMS, HRSA, OIG, DOE, Dept. of Commerce etc.)
- 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. Utilizes Medicaid and Contractor guidelines for coverage determinations.
- 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, to maintain confidentiality, to meet deadlines, and to 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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Financial AuditingData MiningTrend AnalysisMedical Record DocumentationBilling and Coding ReviewInvestigative SkillsGovernment Accounting PrinciplesAudit PoliciesICD-9-CMICD-10-CM
Soft Skills
Strong Communication SkillsInterpersonal SkillsOrganizational AbilitiesInitiativeTeam Collaboration
Tools & Technologies
Microsoft OfficeExcelWordInvestigation ToolsDatabases
Industry Keywords
MedicaidMedicareFraud DetectionComplianceGovernment Programs