Integrity Management Services, Inc.

Compliance

• Applies in-depth knowledge of federal and state regulations and healthcare 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 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.
• Program research relating to federal program applications, eligibility, payments, and other program requirements.
• Conducts on-site visits and/or interviews as required for investigation.
• Identify weaknesses in current audit processes and recommend enhancements for improved efficiency and effectiveness.
• Performs ad hoc tasks/duties as assigned.

Medicaid Audit and Compliance Specialist

Program Manager

• Provide executive oversight and direction for program operations, ensuring performance aligns with contractual requirements, government guidance, and quality standards.
• Serve as a senior interface with government stakeholders, supporting governance, performance reviews, issue resolution, and risk management.
• Lead integrated teams and subcontractor partners to deliver efficient, compliant, and timely program outcomes.
• Oversee healthcare program integrity activities, including data-driven analysis, audits, oversight activities, and stakeholder communications.
• Ensure high-quality delivery of program outputs such as analytic reports, alerts, and external communications.
• Provide leadership for audit planning, execution, documentation, and corrective action processes.
• Oversee operational workflows for correspondence management, issue tracking, and responsiveness to external stakeholders.
• Lead coordination with related federal contractors and oversight entities to support aligned program execution and avoid duplication of effort.
• Support transition and implementation activities for new or expanding federal programs, ensuring continuity of operations.
• Ensure compliance with federal security, privacy, training, and records management requirements.

Director, Federal Health Program Operations

Capture Manager

• Lead capture efforts for assigned federal opportunities from identification through proposal kickoff
• Develop and execute Capture Plans, win strategies, and customer engagement plans
• Conduct customer, competitor, and incumbent intelligence analysis to shape positioning
• Partner with BD leadership to drive bid/no-bid decisions and pursuit prioritization
• Identify, negotiate, and manage teaming relationships with strategic industry partners
• Collaborate with operations, SMEs, and proposal teams to align solution development with customer needs
• Support responses to RFIs, Sources Sought, and other pre-solicitation activities
• Ensure IntegrityM enters proposal phase with clear win themes, discriminators, and solution readiness