• 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.