Medicaid Auditor (Full-time, Remote)
This is the employer's own posting, not a copy on a job board.
What we know
Is it still open?
Confirmed still open
Last checked 2d ago — checked against the employer's own applicant tracking system, which is the company answering directly.
We re-read the employer's own applicant tracking system and the posting was still there. That is the company answering directly.
How old is it?
Posted 12d ago
The date the source published, not the day we noticed it (2026-10-21). Last seen at its source 4h ago.
We have tracked this listing since 21 Oct 2026 (12 days). The employer's own board has carried it every time we have read it, most recently 4 hours ago.
Is it remote?
Marked remote on the employer's board
Their board carries a remote setting on this posting — a field they filled in, not wording we read. The location field names somewhere specific, which is usually where the team or the entity sits.
Who may apply?
United States
The description states no restriction of its own. This is the source's own tag.
Pay
$55k–75k/yr
Read out of the job description by us, not from a structured field. Shown in the posting's own currency and period; we never convert.
Skills named in the ad
Recognised terms only, from a fixed vocabulary — this is what CV matching compares against.
Carried by 1 source
-
Workable employer's own board first seen 12d ago · last seen 4h ago
The listing
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!
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.