Auditor 2 - Zero Balance
November 12
Description
• Healthcare Auditors develop contract models for analysis and identify potential insurance reimbursement issues through extensive reviews of hospital claim data and related documents. • Create and update audit plans, model pricing documents, review insurance payments, identify risk areas, develop specifications and procedures, and present documentation of findings. • Work with data analyst team and across project teams to research underpayment trends and improve processes.
Requirements
• High School Diploma or equivalent required • Minimum of 3 years of experience working with large sets of (healthcare) data • Minimum of 2 years of experience in areas of research and analysis • Minimum of 2 years of experience with managed care contracts (government and commercial) and hospital reimbursement • Minimum of 2 years of experience working with inpatient claims • Minimum of 1 year of experience working with Medicare, Medicaid, outpatient facility claims • Minimum of 1 year of experience with contract modeling • Ability to translate complex contract language and healthcare data into actionable information and insights • Ability to work independently to solve problems and recommend technical solutions (ex. provide calculation/formula to price in Alteryx) • Intermediate Excel skills, including knowledge of complex formulas and functions (CONCATENATE, IF, pivot tables) • Basic knowledge of Access (link tables, select/update query, manipulate data in tables) and SQL preferred • Strong verbal and written communication skills • Strong organization skills and attention to detail
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