Internal Provider Auditor

3 days ago

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

💵 $21 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Guide Healthcare

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Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.

Physiotherapy • Podiatry • Speech Pathology • Dietetics • Recruitment

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

🎯 Recruitment

📋 Description

• As an Internal Provider Auditor, you will ensure the accuracy of the provider set ups in the internal software and access database based off client contracts. • This role will be responsible for providing results and education to the Provider Operations team. • Conduct routine monitoring and audits of providers within the internal software. • Conduct quality audits on the provider operations department’s entries of providers. • Audit monthly rosters as entered by provider operations. • Understand and stay current with client contract criteria and requirements in relation to the providers. • Monitor internal and external processes to detect any practices that, either directly or indirectly, result in fraud, abuse or waste that results in unnecessary costs. • Run access queries as needed for administrative purposes. • Assist claims auditors and contractual compliance auditors in additional compliance and auditing responsibilities. • Consistently exercise independent judgment and discretion in matters of significance. • Other duties and responsibilities as assigned.

🎯 Requirements

• Minimum 3 years of experience in the healthcare or managed care industry, including claims/reimbursement experience, professional analytics-related experience and experience working on/managing major projects. • Advanced to expert proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access. • Able to problem solve, exercise initiative, and make low to medium level decisions. • Thorough understanding of current federal, state, and local healthcare compliance requirements. • Ability to meet deadlines and prioritize tasks; collect, correlate, and analyze data. • Ability to work independently with minimal supervision and as part of a team. • Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player. • Effective written and oral communication.

🏖️ Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs. • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered. • Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution. • Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected. • Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times. • Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals. • Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need. • Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.