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Medicaid Program Integrity Reviewer

Woodlawn, MD
Analytica is seeking a Medicaid Program Integrity Reviewer to support a federal government client in Woodlawn, MD.   Analytica has been recognized by Inc. Magazine as the fastest-growing private US small business.  We work with U.S. government customers in health, civilian, and national security missions.  We offer competitive compensation with opportunities for bonuses, employer paid health care, training and development funds, and 401k match.
Responsibilities include (But Are Not Necessarily Limited To):
  • Interact with complex claims/audits to identify inaccurate adjudications.
  • Onsite focused review interviews will assess risk areas including, but not limited, to personal care services, managed care, provider enrollment, and non-emergency medical transportation.
  • Conduct reviews of the information gathered to assess compliance with regulations and summarize in a briefing document for CMS with policy analyst and SME.
  • SME in ensuring compliance to policies, procedures, and state and federal regulations.
  • Work with the state to gather documents and state processes needed to assess the program’s compliance with state/federal regulations
Basic Qualifications:
  • Bachelors’ degree or higher
  • 3+ years of experience as an Auditor/Analyst
  • Experience with CMS program integrity audits (Medicaid)
  • Must be able to perform a State Medicaid audit based on determined processes and protocols with minimal supervision
  • Must be able to travel during the year to perform audit tasks
About ANALYTICA: Analytica is a leading consulting and information technology solutions provider to public sector organizations supporting health, civilian, and national security missions. Founded in 2009 and headquartered in Washington D.C., the company is an established SBA certified HUBZone and 8(a) small business that has been recognized by Inc. Magazine each of the past three years as one of the 250 fastest-growing companies in the U.S.  Analytica specializes in providing software and systems engineering, information management, analytics & visualization, agile project management, and management consulting services. The company is appraised by the Software Engineering Institute (SEI) at CMMI® Maturity Level 3 and is an ISO 9001:2008 certified provider.
 
 
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