Medical Review Auditor Analyst II (Durham / RTP /Raleigh territory)

Recruiter
Conduent Business Services, LLC.
Location
Durham, North Carolina, United States
Salary
Competitive salary
Posted
23 Jun 2021
Closes
24 Jun 2021
Ref
12989583
Job role
Audit
Responsibility Statements
  • Audits medical bills for unrelated charges.
  • Assesses payments against regulatory or administrative charges, coding, and billing errors to determine if fraud or inaccurate billing has occurred.
  • Assists in the development and implementation of new audit/review methodologies to identify overpayments and underpayments to providers, and detect healthcare fraud, waste, and abuse.
  • Prepares written case summaries and represents clients and Conduent as an expert witness.
  • Applies knowledge of provider billing and patient accounting practices to the research of client policy and data to reveal new overpayment recovery opportunities.
  • Develops, maintains, and ensures adherence to multiple project schedules.
  • Achieves percent of savings expectations through their review billing.
  • Ensures productivity goals are met daily.
  • Communicates audit findings to clients.
  • Participates in planning, daily meetings, and backlog sessions.
  • Performs other duties as assigned.
  • Complies with all policies and standards.
Requirements
  • Bachelor's Degree (4 year) required
  • Strong analytics skills (ie. auditing, accounting, book keeping, or relevant course work)
  • Good professional relationship building and networking skills
  • Previous healthcare administration experience is a plus, but not required.
  • Must live within the Durham /RTP/Raleigh area to drive to hospitals for claims auditing.
  • 50% driving, "local " travel is required and 50% is virtual.
Job Track Description:
  • Requires formal education and relevant expertise in a professional, sales, or technical area.
  • Performs technical-based activities.
  • Contributes to and manages projects.
  • Uses deductive reasoning to solve problems and make recommendations.
  • Interfaces with and influences key stakeholders.
  • Leverages previous knowledge and expertise to achieve results.
  • Ability to complete work self-guided.
  • College or university degree required.
General Profile
  • Requires knowledge and experience in the field.
  • Will acquire higher-level knowledge and skills.
  • Develops an understanding of the company, processes, and customers.
  • Uses existing procedures to solve routine or standard problems.
  • Receives moderate guidance and direction from others.
Functional Knowledge
  • Requires expanded conceptual understanding of theories, practices, and procedures.
Business Expertise
  • Uses an understanding of key business drivers to accomplish work.
Impact
  • Impacts a team, by example, through the quality service and information provided
  • Works within guidelines and policies.
Leadership
  • No supervisory responsibilities.
  • Provides informal guidance to new team members.
Problem Solving
  • Uses existing procedures to solve standard problems.
  • Examines information and standard practices to make judgments.
Interpersonal Skills
  • Exchanges complex information and ideas effectively

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