Integrity Management Services

Healthcare program integrity and FWA prevention

Medicaid Auditor

Internal Audit & ControlsConfirmed live in the last 24 hours

Full-timeRemote in USA$55k - $75k /yr

About the Job

Requirements

A bachelor's degree in finance, accounting, or a related field is required.
Five to seven years of related experience in finance, accounting, or auditing is required.
Intermediate knowledge of internal audit policies and operating principles is required.
Intermediate knowledge and experience auditing Medicare/Medicaid and other government payment and oversight programs, including CMS, HRSA, OIG, DOE, and the Department of Commerce, is required.
Knowledge and experience applying government accounting principles and standards, including Generally Accepted Government Auditing Standards, is required.
Investigative skills are required.
Data analysis skills are required.
Knowledge of medical terminology, ICD-9-CM, ICD-10-CM, HCPCS Level II, and CPT codes is required, along with the ability to use Medicaid and contractor guidelines for coverage determinations.
Experience reviewing claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases is required.
Oral and written communication, interpersonal, and organizational abilities are required.
The ability to take initiative, maintain confidentiality, meet deadlines, and work in a team environment is required.
The ability to report work activity in a timely manner is required.
The ability to work independently and as part of a team to deliver high-quality work is required.
The ability to multitask and prioritize assignments while meeting deadlines is required.
Proficiency in Microsoft Office, specifically Microsoft Word and Excel, is required.
Alignment with IntegrityM's mission, vision, values, and operating principles is required.
Candidates must pass post-hire background screening checks.
Remote workers must have wired and/or wireless internet access.

Responsibilities

Perform and report on audits of 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 assignments, which may include desk reviews and/or on-site reviews as determined by federal and state regulations.
Review case management, program payment appropriateness, program and policy compliance, billing, coding, and medical record documentation, and research and analyze industry trends.
Follow audit plans and methodologies specific to contract requirements.
Prioritize and assign workload while ensuring adherence to task order policies and procedures.
Examine and calculate data from financial documents and statements, including provider cost reports, as an audit method.
Use data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns.
Attend on-site audits to retrieve medical records and conduct provider entrance and exit conferences.
Prepare and submit medical record request letters to providers in connection with medical record requests or suspension overpayment determinations.
Interpret and apply relevant laws, regulations, policies, and procedures to audit findings and the provider type being audited.
Apply Generally Accepted Government Auditing Standards to applicable audits to identify fraud, waste, or abuse.
Prepare factual, objective written reports in accordance with professional auditing and evaluation standards, and present findings to leadership, external agencies, and government partners.
Calculate improper payments and issue findings, recommendations, and corrective actions in accordance with applicable regulations, policies, and procedures.
Prepare and send suspension overpayment determinations to providers when applicable.
Communicate with federal and state agencies and providers about regulatory compliance, audit findings, and the recovery process.
Attend briefings and presentations as assigned.
Maintain fraud case development quality standards and ensure cases are properly prepared.
Maintain timely updates in the appropriate investigation tools and applications, case development databases, and documents.
Develop and document investigative findings, compile case file documentation, calculate improper payments, and issue findings, recommendations, and corrective actions in accordance with applicable regulations, policies, and procedures.

Medicaid Auditor (Full-time, Remote)

Integrity Management Services, Inc. · Alexandria, United States (Remote) · — · Posted 2026-10-21

Workplace: remote

Department: Operations

Description

About Us

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.

At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!

www.integritym.com

In this role, the Medicaid Auditor will be responsible for performing and reporting on Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse; issue findings and recommendations; and identify improper payments. Audit assignments can be programmatic or financial and may range from desk reviews and/or onsite review activities as determined by federal and state regulations. Specific review types may include case management, program payment appropriateness, program and policy compliance, billing, coding and medical record documentation reviews, as well as research and analysis of industry trends.

Job Responsibilities:

Comprehends and follows auditing plans and methodologies specific to contract requirements.
Prioritization and assignment of workload, ensuring adherence to task order policies and procedures.
Examines and calculates data from financial documents and statements such as provider cost reports as a method of audit. 
Utilize data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns.
Attend on-site audits to retrieve medical records and conduct provider entrance/exit conference.
Prepare and submit medical record request letters to providers associated with requests for medical record requests or suspension overpayment determinations.
Interpret and apply pertinent laws, regulations, policies, and procedures relevant to the specific audit findings and provider type being audited.
Ensure Generally Accepted Government Auditing Standards (GAGAS) standards are applied to each applicable audit to identify fraud, waste or abuse.
Preparing factual and objective written reports in conformance with professional auditing and evaluation standards and present findings to leadership, external agencies, and government partners.
Calculates improper payments, and issues findings, recommendations, and corrective actions in accordance with applicable regulations, policies and procedures.
Prepare and send suspension overpayment determinations to providers when applicable.
Communicates with federal/state agencies and providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.
Attends briefings and presentations as assigned.
Maintains fraud case development quality standards so that proper case development is ensured, and quality cases are fully prepared.
Maintains proper and timely updates in appropriate tools and applications for their investigations. Case development databases and documents.
Develops and documents reports of investigative findings, compiles case file documentation, calculates improper payments, and issues findings, recommendations, and corrective actions in accordance with applicable regulations, policies and procedures.

Requirements

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.

Additional Requirements:

Must pass post hire background screening checks.
For remote work, required to have wired and/or wireless internet access.

Benefits

This position is eligible for the benefits applicable to full-time regular employees, such as: 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, and educational benefits.

U.S. remote annual salary range: $55,000-$75,000/annual

For candidates in jurisdictions requiring range disclosure, this is the good-faith range for this role; final pay may vary by work location and job-related factors such as skills, experience, location, and internal equity. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Apply

Apply at Integrity Management Services, Inc.

About the Company

Integrity Management Services

Healthcare program integrity and FWA prevention

Integrity Management Services helps healthcare programs prevent improper payments and fraud, waste, and abuse across federal and nonfederal programs like Medicare, Medicaid, Managed Care, and the Marketplace. Its work combines data analysis, coding and medical reviews, fraud investigations, audits, compliance reviews, grants management, training, and technology solutions to identify and fix program vulnerabilities. A multidisciplinary team of investigators, coders, nurses, statisticians, and data analysts applies large-scale data review to deliver customized, practical solutions. The goal is to safeguard healthcare system integrity while protecting clients and beneficiaries, drawing on 20+ years of experience, an award-winning record, and status as a certified Women-Owned Small Business to provide end-to-end, client-focused services.

Company size: 51-200
Company stage: Not listed
Total funding: Not listed
Headquarters: Alexandria, VA
Founded: 2009

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