Auditor II - Data Mining

EXL • United States,

12h • $19 - $30

About The Position

The Auditor II – DM (Data Mining) reviews query output to identify potential overpayments and conducts audits in accordance with internal policies and procedures, applicable regulations, and contractual agreements between insurers and providers. The role exercises independent decision-making and professional judgment, regularly applying medical claims knowledge. The Auditor determines whether a discrepancy exists and documents findings according to applicable standard documentation guidelines.

Requirements

• Attention to detail.
• Excellent written and oral communication skills.
• Flexibility during times of change, including the ability to adjust to shifting priorities and timelines through analytical and problem-solving capabilities.
• Ability to learn, understand, and apply new technologies.
• Knowledge of CMS guidelines.
• Strong knowledge of HCPC, CPT, and other coding methodologies.
• Knowledge of spreadsheets, word processing, and databases.
• High school diploma or equivalent required.
• College degree or equivalent work experience.
• Must maintain OIG/GSA clearances.

Nice To Haves

• 1–2 years of experience as an auditor.
• 1–2 years of experience with medical claims processing.

Responsibilities

• Review query output for overpayments.
• Follow step-by-step query documentation to validate overpayments.
• Use available claims systems to verify overpayments.
• Document overpayments and non-overpayments in production systems, clearly stating reasons for claims determined not to be overpaid for research and quality assurance purposes.
• Meet quality and production standards.
• Record production tasks and time in the format outlined by Management.
• Communicate to Management any issues that could impede completion of assigned work and work with Management to resolve them.
• Provide feedback to Management on areas for improvement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED