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 In this role, the Medicaid Auditor III 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. The Medicaid Auditor III will perform audits as assigned which consist of but are not limited to performing licensing and exclusion reviews on providers and work with the medical staff to ensure services are reimbursed meet regulatory requirements. The Medicaid Auditor III will work independently as well as collaboratively with other audit staff.    Job Responsibilities:   - 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.     - Ensures compliance with all applicable privacy and security training requirements (both IntegrityM and external/client-based), whether on an annual or ad/hoc basis. Please note: certain position levels (leads, managers, directors or higher) may require additional “role-based” training to ensure compliance with applicable privacy and security requirements.    - Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner.    - Adheres to applicable policies ensuring commitment to quality, compliance and security to protect the confidentiality, integrity, and availability of sensitive data and information.    - Adheres to all IntegrityM and/or client privacy and security protocols governing sensitive and/or business confidential information.

• 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. • Ensures compliance with all applicable privacy and security training requirements (both IntegrityM and external/client-based), whether on an annual or ad/hoc basis. Please note: certain position levels (leads, managers, directors or higher) may require additional “role-based” training to ensure compliance with applicable privacy and security requirements. • Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner. • Adheres to applicable policies ensuring commitment to quality, compliance and security to protect the confidentiality, integrity, and availability of sensitive data and information. • Adheres to all IntegrityM and/or client privacy and security protocols governing sensitive and/or business confidential information.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Seeking a parttime (20 hours a week) inpatient auditor to validate DRGs, Pdx, MCC, CC, SOI, ROM, POA, PCS, and DD. - Must have a minimum of 2 years of recent IP auditing experience - At least 5 years of experience in prior IP coding - Experienced with auditing cases from an academic university health system and trauma level 1 - Comfortable with reviewing cases from all specialties - Experience with Cerner and 3M - Prior to access being granted, approx. 4 hours of learning modules must be completed - Candidate must be able to complete learning modules within 48 hours of being released - Schedule can be flexible within reason, but for initial training (1-2 weeks) must be available for a couple of hours between 8a and 4p Mountain Time each day Qualifications - Minimum of 2 years of recent IP auditing experience - At least 5 years of prior IP coding experience - Experience with auditing cases from an academic university health system and trauma level 1 - Comfortable with reviewing cases from all specialties - Experience with Cerner and 3M Requirements - Completion of approx. 4 hours of learning modules prior to access - Ability to complete learning modules within 48 hours of being released - Availability for initial training (1-2 weeks) between 8a and 4p Mountain Time Benefits - Candidate will be paid for the time spent on learning modules Company Description Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. - Works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners - Serves more than 350 healthcare organizations - Employs 35,000 skilled workers in the United States, India, Colombia, and the Philippines

• Review medical records and associated claim information to validate accuracy of DRG assignments and/or Itemized Billing • Apply coding principles based on industry standards and company/client guidelines • Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record • Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners • Validate itemized bill payments utilizing the UB-04, the itemized bill and industry/client coding guidelines • Provide appeal responses for claims of the above types utilizing industry standards and company/client policies • Assist with new concept development • Assist with claim selection criteria • Maintain certifications and continuing education requirements • May require client communication to support findings