Job Description

Location: Health Choice Management Co.
Posted Date: 5/21/2020

Position Purpose:

This position is responsible for supporting the Internal Audit Team to secure quality of work in the department, assist the Audit Director in the assignment and monitoring of the workload and conduct internal audit reviews. It ensures accurate claims payment and verification that the provider contracts are loaded correctly in accordance with the Arizona Health Care Cost Containment System, Utah Medicaid and The Centers for Medicare and Medicaid Services requirements, rules, regulations and contract agreement.

Responsibilities:

Assure the quality of work within the organization

  • Perform random quality audits of claims processed
  • Conduct financial accuracy audits on all claims paid greater than a value of $2,500.00
  • Performs audits of the provider information and\or Contracts
  • Communicate new information (e.g. AHCCCS policies, AHCCCS encounter changes, Medicare procedures and processes, etc.) to the audit staff and/or other departments
  • Assist in the maintenance of templates and forms and ensure their distribution to applicable departments and staff
  • Ideas for new audit scope based on findings of standard audits are offered

Support the Internal Audit Team

  • Answer job related technical questions
  • Transfer of knowledge through training
  • Provide guidance
  • Assist with assigning and monitoring workload
  • Assist in the development and maintenance of training materials, including but not limited to: policies and procedures, desk reference manual, Medicaid and Medicare updates
  • Train new Internal Auditors

Analyze and document audit results

  • Track and trend audit results and report findings
  • Identified Process improvement opportunities

Support the audit needs of the organization

  • Complete ad-hoc analysis and reports upon request

Perform other duties as assigned:

  • Complete other tasks as assigned to assist with operations of the Internal Department and other functional areas.

Education / Experience / Other Requirements

Education:

  • High School Diploma or equivalent GED
  • Associate or Bachelor’s degree preferred
  • Certified Professional Coder preferred

Years of Experience:

  • At least four (4) years’ experience in a managed care environment
  • At least three (3) years claims processing
  • At least two (2) years of processing or auditing Medicaid and Medicare Part A and B claims

Specialized Knowledge:

  • Experience on different payment methodologies
  • Strong experience on all claim forms (UB04, 1500 and ADA)
  • Previous Medicaid\Medicare experience
  • Computer experience necessary, including MS Access, Excel, Word and Power Point
  • Experience on analyzing data and problem solving

Skills & Abilities:

  • Knowledge of medical terminology
  • Knowledge of ICD-10 (when applicable)
  • Knowledge of CPT Codes and HCPCs codes
  • Knowledge of AHCCCS and CMS rules, regulations and guidelines
  • Claims processing

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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