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 – Full-time

IT Support

• **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!
• www.integritym.com
• **Position Summary ****IntegrityM is seeking an experienced Audit Manager to lead and oversee complex healthcare program audits in support of federal oversight initiatives. This full-time leadership role is responsible for managing audit engagements, supervising professional staff, ensuring compliance with government auditing standards, and delivering high-quality audit reports to support program integrity objectives.
• The ideal candidate brings strong experience in healthcare auditing, deep knowledge of federal health program requirements, and demonstrated success managing audit teams in a regulated environment.
• **Key Responsibilities **
• Lead and manage multiple audit engagements from planning through reporting and follow-up. **• Develop audit work plans, risk assessments, and testing methodologies. **• Ensure compliance with applicable federal regulations, program guidance, and Government Auditing Standards (GAGAS). **• Supervise, mentor, and evaluate audit staff. **• Review workpapers, findings, and reports for accuracy, quality, and adherence to standards. **• Communicate audit results and recommendations to senior leadership and external stakeholders. **• Identify emerging risks and recommend process improvements. **• Support continuous enhancement of audit methodologies and internal quality controls.

Federal Healthcare Audit Manager

Program Manager

• Serve as the primary point of contact for client leadership and key stakeholders
• Provide executive oversight and management of all contract activities and deliverables
• Lead operational planning, staffing coordination, workload management, and resource allocation activities
• Manage multidisciplinary teams and subcontractors to ensure successful contract execution
• Oversee operational performance, quality management, reporting activities, and deliverable schedules
• Monitor program risks, operational metrics, staffing utilization, and project performance
• Ensure timely delivery of high-quality deliverables and operational support activities
• Support implementation of quality assurance and continuous improvement initiatives
• Coordinate stakeholder communications, executive briefings, and operational meetings
• Manage schedules, staffing plans, budgets, and reporting activities
• Support governance, operational oversight, and strategic planning efforts
• Collaborate with operational, compliance, analytics, and technical teams to support successful program execution

Program Director, Federal Healthcare Audit

Auditor

• Perform complex audit and compliance review activities in accordance with program requirements and established methodologies
• Conduct detailed case analysis, evidence review, operational assessments, and compliance testing activities
• Review financial, operational, and supporting documentation to assess compliance with applicable requirements and standards
• Develop and maintain audit workpapers, supporting documentation, and audit records
• Support development of audit findings, recommendations, corrective action assessments, and reporting materials
• Evaluate operational processes, payment activities, and compliance documentation for accuracy and completeness
• Collaborate with program leadership, compliance staff, analysts, and operational teams to support successful audit execution
• Participate in quality review and continuous improvement activities
• Support preparation of reports, summaries, briefings, and operational deliverables
• Assist with issue identification, trend analysis, and operational risk assessments
• Ensure timely completion of assigned tasks and deliverables while maintaining quality and compliance standards

Senior Auditor

Project Manager

Program Director – Senior Project Manager

• Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
• Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity.
• Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed.
• Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
• Support fraud investigators with medical review expertise to detect and address fraudulent activities.
• Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.

Clinical Nurse Coding Auditor

• Lead and manage multiple audit engagements from planning through reporting and follow-up.
• Develop audit work plans, risk assessments, and testing methodologies.
• Ensure compliance with applicable federal regulations, program guidance, and Government Auditing Standards (GAGAS).
• Supervise, mentor, and evaluate audit staff.
• Review workpapers, findings, and reports for accuracy, quality, and adherence to standards.
• Communicate audit results and recommendations to senior leadership and external stakeholders.
• Identify emerging risks and recommend process improvements.
• Support continuous enhancement of audit methodologies and internal quality controls.

Managed Care Audit Manager

Analyst

• Identify and conduct investigations into known or suspected FWA with high autonomy
• Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation.
• Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity)
• Participate in the development and presentation of FWA-related education for assigned Customers
• Perform coding reviews for flagged claims, to support Coding team (if applicable).

SIU Analyst – Investigator

• **Job Title:** **Clinical Nurse Auditor – Payment Integrity**
• **Job Summary****We are seeking an experienced **Clinical Nurse Auditor** to join our **Payment Integrity** team. In this role, you will leverage your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by healthcare providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and integrity in reimbursement practices. This position requires a **Registered Nurse (RN)** with coding certifications such as **CPC** (Certified Professional Coder), **CIC** (Certified Inpatient Coder), **CDI** (Clinical Documentation Improvement), or a similar credential, through **AAPC** or **AHIMA**. Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential.
• **How You Will Make an Impact **
• - **Investigations and Audits**: Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
• - **Tool and Policy Development**: Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity.
• - **Cross-Departmental Collaboration**: Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed.
• - **Data Analysis and Trending**: Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
• - **Fraud Detection Support**: Support fraud investigators with medical review expertise to detect and address fraudulent activities.
• - **Mentorship**: Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.