Remote opportunity at
Integrity Management Services, Inc.Medicaid Auditor (Full-time, Remote)
Integrity Management Services, Inc. is hiring a full-time Medicaid Auditor to join its team on a remote basis. The organization assists commercial and government clients with…
Career Tools
About This Role
Integrity Management Services, Inc. is hiring a full-time Medicaid Auditor to join its team on a remote basis. The organization assists commercial and government clients with compliance, program integrity, and the prevention of waste, fraud, and abuse through data analytics, technology solutions, audits, investigations, and medical reviews. In this position, the auditor will examine Medicaid Managed Care Plans and providers to detect improper payments, issue recommendations, and uncover potential fraud…
Job Description
Integrity Management Services, Inc. is hiring a full-time Medicaid Auditor to join its team on a remote basis. The organization assists commercial and government clients with compliance, program integrity, and the prevention of waste, fraud, and abuse through data analytics, technology solutions, audits, investigations, and medical reviews. In this position, the auditor will examine Medicaid Managed Care Plans and providers to detect improper payments, issue recommendations, and uncover potential fraud or abuse.
The role involves conducting both financial and programmatic audit assignments, which may include desk reviews and on-site activities as mandated by state and federal regulations. Responsibilities encompass analyzing financial documents, utilizing data mining tools, attending on-site provider visits, and preparing objective written reports that adhere to professional standards. The successful candidate will communicate regularly with federal and state agencies, maintain case development quality standards, and calculate improper payments.
Responsibilities
- Execute and follow audit plans and methodologies that align with contract requirements
- Examine and calculate financial documents and provider cost reports during audits
- Apply data mining and trend analysis instruments to spot anomalies in billing and payment patterns
- Participate in on-site audits to gather medical records and lead entrance and exit conferences with providers
- Draft and dispatch medical record request letters and suspension overpayment determinations
- Interpret and enforce relevant laws, regulations, and policies for specific provider types
- Apply Generally Accepted Government Auditing Standards to detect fraud, waste, or abuse
- Draft objective written evaluation reports and present findings to leadership, external agencies, and government partners
- Compute improper payments and issue corrective actions, recommendations, and findings
- Communicate with providers and federal or state agencies regarding regulatory compliance and the recovery process
- Maintain up-to-date investigation records in case development databases
- Track work activity promptly and adhere to task order procedures
Requirements
- Bachelor’s Degree in finance, accounting, or a related field
- Five to seven years of related experience in auditing, accounting, or finance
- Intermediate understanding of internal audit operating principles and policies
- Intermediate experience and knowledge in auditing government payment and oversight programs such as Medicare and Medicaid
- Familiarity with government accounting principles and standards, including GAGAS
- Investigative skills and strong data analysis capabilities
- Understanding of medical terminology, CPT, HCPCS level II, ICD-9-CM, and ICD-10-CM codes
- Capability to review claims for billing and medical coding compliance, conduct medical reviews, or build fraud cases
- Strong interpersonal, organizational, and oral and written communication abilities
- Capacity to maintain confidentiality, take initiative, meet deadlines, and collaborate in a team setting
- Proficiency in Microsoft Word and Excel
- Alignment with the mission, values, vision, and operating principles of Integrity Management Services, Inc.
- Ability to pass a post-hire background check
- Wired and/or wireless internet access for remote work
Core Skills
Benefits
- Vacation
- Sick leave
- Paid holidays
- Health insurance
- Dental insurance
- Vision insurance
- Short-term and long-term disability
- Life insurance
- Employee assistance plan
- 401(k) retirement plan
- Educational benefits
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, this role is remote, though candidates must have wired and/or wireless internet access.
What is the salary range for the Medicaid Auditor role?
The annual salary range is $55,000 to $75,000, though final pay may vary based on factors such as location, experience, and internal equity.
What education and experience are required?
Applicants must hold a Bachelor’s Degree in accounting, finance, or a related field, alongside five to seven years of related professional experience.
What benefits are included?
Full-time regular employees are eligible for vacation, sick leave, paid holidays, health, dental, vision, life, and disability insurance, an employee assistance plan, a 401(k) plan, and educational benefits.
Sample Interview Questions
AI-generated questions tailored to this specific role — a preview of the full practice set.