Medicaid Audit and Compliance Specialist
New
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Integrity Management Services, Inc.Healthcare Compliance
Alexandria, Virginia, United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5-7 Years
- Required Skills
- Data AnalysisMicrosoft ExcelFinancial analysis
Requirements
- Bachelor’s Degree in finance, accounting or related field.
- 5-7 years of related experience in finance, accounting, or auditing.
- Intermediate knowledge of internal audit policies and operating principles.
- Experience auditing Medicare/Medicaid and government oversight programs.
- Knowledge of Generally Accepted Government Auditing Standards (GAGAS).
- Strong investigative and data analysis skills.
- Knowledge of medical terminology, ICD-9-CM, ICD-10-CM, HCPCS level II and CPT codes.
- Experience reviewing claims for billing and medical coding requirements.
- Proficiency in Microsoft Office (Word, Excel).
- Must pass post-hire background screening.
Responsibilities
- Perform and report on Medicaid Managed Care Plans and providers to identify fraud, waste, and abuse.
- Issue findings, recommendations, and identify improper payments.
- Examine financial documents and provider cost reports.
- Utilize data mining and trend analysis to detect billing anomalies.
- Conduct onsite audits, retrieve medical records, and hold provider conferences.
- Interpret and apply federal/state regulations and GAGAS standards.
- Prepare factual written reports for leadership and government partners.
- Maintain fraud case development quality standards and documentation.
- Conduct program research and identify process enhancements.
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