Medicaid Audit and Compliance Specialist

Integrity Management Services, Inc.

. Applies in-depth knowledge of federal and state regulations and healthcare industry standards.

Posted 4/7/2026full-timeRemote • Virginia • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.

Benefits

Comp & perks

🌐 Worldwide Post a Job Affiliates ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs Account Integrity Management Services, Inc. Website LinkedIn All Job Openings 51 - 200 employees 📋 Compliance 🏛️ Government 🎯 Recruiter Compliance
Government
Recruitment Integrity Management Services, Inc. is a women-owned, women-run company specializing in helping government and commercial enterprises minimize the risk of improper payments, fraud, waste, and abuse. The company provides a range of services including data analytics, fraud investigations, compliance reviews, audits, grants management, staff augmentation, and coding and medical reviews. IntegrityM, as they are known, works closely with Federal Government agencies, state agencies, and private sector organizations to drive informed decisions and enhance program transparency and oversight. The company is recognized for its contributions to the community and has been awarded for excellence in government contracting and corporate social responsibility. Medicaid Audit and Compliance Specialist 🔥 1 minute ago ⚔️ Virginia – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🚔 Compliance Apply Now Find Hiring Managers Customize resume for this job ☆ Save ☑️ Mark as applied ❌ Hide Report problem 📋 Description
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. 🎯 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. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Senior Regulatory Engineer – Electrical Distribution 🔥 15 minutes ago Industrial Manufacturing - ⚡ Energy 🤝 B2B Website LinkedIn All Job Openings Senior Regulatory Engineer overseeing compliance with codes and standards for electrical distribution products. Guiding design strategies and collaborating with cross-functional engineering teams. 🇺🇸 United States – Remote 💵 $120k - $165k / year ⏰ Full Time 🟠 Senior 🚔 Compliance Compliance Manager – Customer Compliance, Chargebacks 🔥 3 hours ago The Conair Group 201 - 500 Website LinkedIn All Job Openings Compliance Manager managing customer compliance and chargeback defense at Conair LLC. Leading initiatives to ensure adherence to major retail shipping requirements and optimize warehouse operations. 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🚔 Compliance ERISA Compliance Analyst 🔥 3 hours ago Employee Fiduciary 51 - 200 Website LinkedIn All Job Openings ERISA Compliance Analyst at Employee Fiduciary providing compliance support for retirement plans. Handling nondiscrimination testing and Form 5500 filings with a focus on exceptional client service. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior 🟡 Mid-level 🚔 Compliance Senior Compliance Analyst – Advertising Review 🔥 4 hours ago Cnect 51 - 200 👥 HR Tech 🎯 Recruiter ☁️ SaaS Website LinkedIn All Job Openings Senior Compliance Analyst ensuring retail communication compliance with regulations at Cetera Financial Group. Reviewing and maintaining compliance materials while collaborating with team members in a remote role. 🇺🇸 United States – Remote 💵 $85k - $100k / year ⏰ Full Time 🟠 Senior 🚔 Compliance 🦅 H1B Visa Sponsor Regulatory Capital Reporting Associate – Basel III 🔥 10 hours ago Santander 10,000+ employees 🏦 Banking 💸 Finance 💳 Fintech Website LinkedIn All Job Openings Regulatory Capital Reporting Associate managing Basel III capital reporting and compliance. Collaborating across Risk, Treasury, and Finance while mentoring junior team members. 🇺🇸 United States – Remote 💵 $71.3k - $122.5k / year 💰 Post-IPO Equity on 2013-05 ⏰ Full Time 🟢 Junior 🟡 Mid-level 🚔 Compliance 🦅 H1B Visa Sponsor View More Compliance Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

data analysisauditingfinancial document examinationdata miningtrend analysismedical codingfraud investigationimproper payment calculationgovernment accounting principlesaudit methodology

Soft Skills

strong communication skillsinterpersonal skillsorganizational abilitiesinitiativeconfidentialityteamworkmultitaskingprioritizationdeadline managementreporting