{"id":3010208,"url":"https://alion.io/job/integritym-medicaid-auditor-full-time-remote","title":"Medicaid Auditor (Full-time, Remote)","company":{"id":681143,"name":"Integritym","domain":"integritym.com","url":"https://alion.io/company/integritym","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workable","truth_index":null},"role":"Finance","role_family":"Finance","seniority":null,"employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Alexandria, United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":55000,"max":75000,"currency":"USD","period":"year","gross":null,"usd_annual":75000},"salary_estimate":null,"experience_years_min":null,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Office","optional":false}],"status":"live","first_seen_at":"2026-10-21T15:11:12Z","employer_posted_date":"2026-10-21","last_verified_at":"2026-10-27T03:12:57Z","board_verified":true,"closed_at":null,"days_open":5,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":5},"description":"About Us\nIntegrity 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.\nAt 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!\nwww.integritym.com\nIn 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.\nJob Responsibilities:\nComprehends and follows auditing plans and methodologies specific to contract requirements. \nPrioritization and assignment of workload, ensuring adherence to task order policies and procedures. \nExamines and calculates data from financial documents and statements such as provider cost reports as a method of audit. \nUtilize data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns. \nAttend on-site audits to retrieve medical records and conduct provider entrance/exit conference. \nPrepare and submit medical record request letters to providers associated with requests for medical record requests or suspension overpayment determinations. \nInterpret and apply pertinent laws, regulations, policies, and procedures relevant to the specific audit findings and provider type being audited. \nEnsure Generally Accepted Government Auditing Standards (GAGAS) standards are applied to each applicable audit to identify fraud, waste or abuse. \nPreparing factual and objective written reports in conformance with professional auditing and evaluation standards and present findings to leadership, external agencies, and government partners. \nCalculates improper payments, and issues findings, recommendations, and corrective actions in accordance with applicable regulations, policies and procedures. \nPrepare and send suspension overpayment determinations to providers when applicable. \nCommunicates with federal/state agencies and providers regarding issues such as general regulatory compliance, audit findings, and the recovery process. \nAttends briefings and presentations as assigned. \nMaintains fraud case development quality standards so that proper case development is ensured, and quality cases are fully prepared. \nMaintains proper and timely updates in appropriate tools and applications for their investigations. Case development databases and documents. \nDevelops 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. \nRequirements\nBachelor’s Degree in finance, accounting or related field required. \n5-7 Years of related experience in finance, accounting, or auditing. \nIntermediate knowledge of internal audit policies and operating principles. \nIntermediate knowledge and experience in auditing Medicare/Medicaid and other government payment and oversight programs. (CMS, HRSA, OIG, DOE, Dept. of Commerce etc.) \nKnowledge and experience in the application of government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS). \nExperienced investigative skills. \nStrong data analysis skills. \nKnowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS level II and CPT codes. Utilizes Medicaid and Contractor guidelines for coverage determinations. \nExperience in reviewing claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases. \nStrong oral and written communication skills, strong interpersonal skills, and superior organizational abilities. \nAbility to take initiative, to maintain confidentiality, to meet deadlines, and to work in a team environment. \nAbility to report work activity on a timely basis. \nAbility to work independently and as a member of a team to deliver high quality work. \nAbility to multitask and prioritize assignments while meeting deadlines. \nProficiency in Microsoft Office, specifically Microsoft Word and Excel. \nPassion and alignment with IntegrityM’s mission, vision, values and operating principles. \nAdditional Requirements:\nMust pass post hire background screening checks.\nFor remote work, required to have wired and/or wireless internet access.\nBenefits\nThis 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.\nU.S. remote annual salary range: $55,000-$75,000/annual\nFor 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.\nIntegrityM 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.","description_format":"text","description_chars":6540,"description_truncated":false,"requirements":{"experience_years_min":null,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":["Dental insurance","Equity","Flexible schedule","Health insurance","Life insurance","Professional development","Retirement plans","Vision insurance"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Health Insurance & Benefits","Digital Government","Management Consulting"],"lifecycle":[{"event":"open","at":"2026-10-21T15:11:12Z"}],"visa":[],"liveness":{"score":86,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.86,"p_room":1,"age_days":5,"expected_fill_days":27,"reasons":["conf:2","win:early"],"computed_at":"2026-10-27T05:46:45Z"},"pay":{"stated_usd_annual":75000,"is_top_pay":false},"html_url":"https://alion.io/job/integritym-medicaid-auditor-full-time-remote","json_url":"https://alion.io/job/integritym-medicaid-auditor-full-time-remote.json","meta":{"generated_at":"2026-10-27T06:05:49Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":6142,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-28T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":681143},"rest":"https://alion.io/mcp/rest/get_company?id=681143"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fintegritym-medicaid-auditor-full-time-remote"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fintegritym-medicaid-auditor-full-time-remote"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fintegritym-medicaid-auditor-full-time-remote"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/integritym-medicaid-auditor-full-time-remote\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fintegritym-medicaid-auditor-full-time-remote"}]}