reputed company Audit and Compliance Specialist (Full-time, Remote)
reputed company
reputed company. (IntegrityM) is an award-reputed company, women-owned small business specializing in assisting government and reputed company clients in compliance and program reputed company 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 reputed company off of these reputed company reputed company that reputed company IntegrityM a great reputed company to work. Our small, flexible workplace offers an exceptional reputed company of life and promotes corporate-driven sustainability. We deliver creative solutions that reputed company goals and foster a dynamic, idea-driven environment that nurtures our employees’ reputed company development. Large company perks…Small company feel!
In this role, the reputed company Audit and Compliance Specialist will be responsible for performing and reporting on reputed company 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 reputed company 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 reputed company as research and analysis of industry trends. The reputed company Audit and Compliance Specialist will reputed company 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 reputed company Audit and Compliance Specialist will work independently as reputed company as collaboratively with other audit staff.
Job Responsibilities:
- 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 reputed company 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 reputed company to reputed company applicable audit to identify fraud, waste or abuse.
- Preparing factual and objective written reports in conformance with reputed company 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 reputed company 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 reputed company standards so that reputed company case development is ensured, and reputed company cases are fully reputed company.
- Maintains reputed company and reputed company 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 reputed company and/or interviews as required for investigation.
- Identify weaknesses in reputed company audit processes and recommend enhancements for improved efficiency and effectiveness.
- Performs reputed company tasks/duties as assigned.