Integrity Management Services, Inc.

• 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.

• 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.

**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.

• 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

• 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.

• 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

• 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

• 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).

Job Summary We are seeking a detail-oriented SIU Analyst/Investigator to join our team. In this role, you will play a crucial role in ensuring the accuracy, compliance, and integrity of healthcare claims through comprehensive audits, analyses, and process improvements. The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change in aberrant behavior observed in our healthcare customer's claims and enrollment data. You will work both independently and with a team of clinical SMEs to analyze data, assess exposure, and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting for FWA recoupments and savings. Key Responsibilities - 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).

Integrity Management Services, Inc. (IntegrityM) is a woman-owned small business specializing in assisting government healthcare organizations prevent and detect fraud and abuse in their programs. At IntegrityM, we offer a culture of opportunity, recognition, and collaboration. We thrive off of these fundamental elements that make IntegrityM a great place to work. We offer the flexibility our employees need to challenge themselves and focus on advancing their professional development and careers. Large company perks. Small company feel. www.integritym.com In this role, the Statistician with guidance from the Senior Data Analyst or Sr. Statistician and Mangers will provide analytical and statistical data support utilizing statistical software. Statistician possesses a statistical education background and general knowledge of health care systems, basic computer and software skills, and ability to accomplish all delegated tasks achieving Integrity Management Services business goals producing high quality deliverables to our clients. Statistician works independently as well as collaboratively with Data Analysis team. Job Responsibilities:   Works with databases performing functions including data cleaning and maintenance; extracting data, importing/exporting data into various formats.   Perform complex statistical analyses of Medicare Fee-For-Schedule (FFS) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) claims data and create reports on trends, significant changes and other relevant factors.   Creates materials that aid in illustrating analytics/data findings.   Compiles, verifies, and interprets data to guide departmental efforts.   Conduct quantitative and qualitative data mining and statistical analyses: ·        Uses SAS, MS Access, and Excel. ·        Performs data analysis to create summaries and result tables. ·        Runs summary statistics. ·        Conducts research relevant to the analysis being done. ·        Refines database queries to generate subsets of databases and tables. ·        Creates clear, concise, and complete materials including but not limited to reports, memos and/or data files for submission to the client. ·        Create project presentations at the request of manager and other stakeholders.                             Communicates with technical and non-technical end users, providing clear explanation of procedures used and results obtained from data analysis tasks.    Provides analytical support for internal quality reviews, audits, and client inquiries, including validating results and responding to data-related questions.   Seeks opportunities for additional training to improve skills necessary to perform job responsibilities.   Leads and/or participates in team projects and brainstorming sessions to assess various methodologies for study designs.   Remains informed regarding industry changes, trends, best practices and applicable regulations and assesses impact of changes on the project.   Performs ad hoc tasks/duties as assigned.