Healthcare Fraud Auditor
Integrity Management Services, Inc.
Alexandria , VA 22301
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Integrity Management Services, Inc. (IntegrityM) is a women owned small business specializing in assisting government healthcare organizations prevent and detect fraud and abuse in their programs. We are now seeking a Healthcare Fraud Auditor to join our team. In this role, the Healthcare Fraud Auditor will be responsible for performing and reporting on program audits and investigative reviews. 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 (grants, loans etc.), program and policy compliance, billing, coding and medical record documentation reviews, as well as research and analysis of industry trends. The Auditor will work independently as well as collaboratively with other audit staff and report to the Program Director. The individual applies an intermediate level of subject matter knowledge to solve a variety of common business issues.
- Maintains strict compliance, confidentiality and security of the personal health information contained in the data sources.
- Comprehend and follow auditing plans and methodologies specific to contract requirements.
- Develop and document reports of investigative findings, compile case file documentation, improper payments, and issue findings, recommendations, and corrective actions in accordance with applicable regulations, policies and procedures.
- Examine financial documents and statements such as provider cost reports as a method of audit.
- Program research relating to federal program applications, eligibility, payments, and other program requirements.
- Communicate with federal/state agencies and providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.
- Apply in-depth knowledge of federal and state regulations and healthcare industry standards
- Document work performed and audit results based on standards and guidelines, preparation of internal and external reports
- Identify and recommend policy, procedure and system changes
- Adheres to IntegrityM Quality Management (QM) Program procedures including: following the Standard Operating Procedures (SOPs), Desk Level Procedures (DLPs) and Peer Review protocols and organization-wide policies and procedures in areas assigned, resolving problems that might affect or be encountered by others, identifying and sharing best practices that could be helpful to others and documenting all work by following established procedures.
- Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner.
- Adheres to applicable policies ensuring commitment to quality, compliance and security to protect the confidentiality, integrity, and availability of sensitive data and information.
- Works on problems of moderately complex scope.
- Acts as an informed team member providing analysis of information and limited project direction input.
- Exercises independent judgment within defined practices and procedures to determine appropriate action.
- Follows established guidelines and interprets policies.
- Evaluates unique circumstances and makes recommendations.
Qualified candidates will possess the following:
- Bachelors Degree in related field required.
- At least 2-5 Years of experience that is directly related to the duties and responsibilities specified, related experience in finance, accounting or audit.
- 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 GAGAS.
- Strong communication and interpersonal skills.
- Ability to clearly communicate information to professionals as well as the general public.
- Ability to adapt and modify medical billing procedures and documentation requirements.
- Ability to provide guidance and training to professional staffs in area of expertise.
- Intermediate understanding of Medicare/Medicaid or healthcare auditing and their revenue cycles.
- Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel.
- Basic project management skills.
- Intermediate financial and business acumen.
- Strong research and analytical skills.
- Intermediate risk assessment and scoping skills.
Enthusiastic individuals who can work effectively in a dynamic environment both in a team as well as independently is a must!
This is a full-time employee position.
All candidates MUST pass a background check and drug screening prior to employment. (Education, Employment, Credit, Criminal, and a hair sample drug test.)
Integrity Management Services, Inc. (IntegrityM) is a women owned small business specializing in assisting government healthcare organizations prevent and detect fraud and abuse in their programs. With a highly professional staff of data analysts, statisticians, medical professionals, auditors, investigators, evaluators, and regulatory analysts, IntegrityM focuses on helping ensure the integrity of healthcare program regulations and policy. Services offered by IntegrityM include:
- Data aggregation and claims analysis
- Regulatory Analysis
- Program compliance, oversight, and review