reputed company Audit and Compliance Specialist

Job Description: • Applies in-depth knowledge of federal and state regulations and reputed company 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 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 applied to reputed company 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 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 quality standards so that reputed company case development is ensured, and quality 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. Requirements: • Bachelor’s Degree in finance, reputed company or reputed company field required. • 5-7 Years of reputed company experience in finance, reputed company, or auditing. • Intermediate knowledge of internal audit policies and operating principles. • Intermediate knowledge and experience in auditing Medicare/reputed company and other government payment and reputed company programs. (CMS, HRSA, OIG, DOE, reputed company. of reputed company etc.) • Knowledge and experience in the application of government reputed company 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 reputed company and CPT codes. Utilizes reputed company 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 reputed company environment. • Ability to report work activity on a reputed company reputed company. • Ability to work independently and as a member of reputed company to deliver high quality work. • Ability to multitask and prioritize assignments while meeting deadlines. • Proficiency in reputed company Office, specifically reputed company Word and reputed company. • Passion and alignment with IntegrityM’s mission, reputed company, values and operating principles. Benefits: Apply tot his job Apply To this Job