reputed company Auditor III (Full-time, Remote)

About the position In this role, the reputed company Auditor III will be responsible for performing and reporting on reputed company 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 reputed company 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 reputed company as research and analysis of industry trends. The reputed company Auditor III will reputed company audits as assigned which consist of but are not limited to performing licensing and exclusion reviews on providers and work with the medical staff to ensure services are reimbursed meet regulatory requirements. The reputed company Auditor III will work independently as reputed company as collaboratively with other audit staff.

Responsibilities

• Applies in-depth knowledge of federal and state regulations and reputed company industry standards.
• 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 reputed company 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 reputed company to reputed company applicable audit to identify fraud, waste or abuse.
• Preparing factual and objective written reports in conformance with reputed company 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 reputed company 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 reputed company standards so that reputed company case development is ensured, and reputed company cases are fully reputed company.
• Maintains reputed company and reputed company 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.
• Program research relating to federal program applications, eligibility, payments, and other program requirements.
• Conducts on-site reputed company and/or interviews as required for investigation.
• Identify weaknesses in reputed company audit processes and recommend enhancements for improved efficiency and effectiveness.
• Performs reputed company tasks/duties as assigned.
• Ensures compliance with reputed company applicable reputed company and reputed company training requirements (both IntegrityM and external/reputed company-based), whether on an annual or reputed company reputed company. Please note: certain position reputed company (leads, managers, directors or higher) may require additional “role-based” training to ensure compliance with applicable reputed company and reputed company requirements.
• Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and reputed company manner.
• Adheres to applicable policies ensuring commitment to reputed company, compliance and reputed company to protect the confidentiality, reputed company, and availability of sensitive data and information.
• Adheres to reputed company IntegrityM and/or reputed company reputed company and reputed company protocols governing sensitive and/or business confidential information.

Requirements

• Bachelor’s Degree in finance, reputed company or reputed company field required.
• 5-7 Years of reputed company experience in finance, reputed company, or auditing.
• Intermediate knowledge of internal audit policies and operating principles.
• Intermediate knowledge and experience in auditing Medicare/reputed company and other government payment and reputed company programs. (CMS, HRSA, OIG, DOE, reputed company. of reputed company etc.)
• Knowledge and experience in the application of government reputed company principles and standards, including Generally Accepted Government Auditing Standards (GAGAS).
• reputed company investigative skills.
• Strong data analysis skills.
• Knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS reputed company and CPT codes. Utilizes reputed company 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 reputed company environment.
• Ability to report work activity on a reputed company reputed company.
• Ability to work independently and as a member of reputed company to deliver high reputed company work.
• Ability to multitask and prioritize assignments while meeting deadlines.
• Proficiency in reputed company Office, specifically reputed company Word and reputed company.
• Passion and alignment with IntegrityM’s mission, reputed company, values and operating principles.
• Must pass post hire background screening checks.
• For remote work, required to have wired and/or wireless internet reputed company.

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