Auditor/Investigator II
Qlarant•CA Home Based, Remote, CA, US, CA
•$56,055 - $83,665
About The Position
Monitors the processing and reconciliation of incoming electronic medical records, importing of prepay claims and records, and generating other operation reports related to process of prepay claims. Supports research of prepay and post-pay record questions as well as research and return of misdirected documents.
Requirements
- Minimum Bachelor's Degree required
- 2 - 4 years of experience required
- Must have investigative experience, preferably in healthcare
Nice To Haves
- 5 - 7 years preferred
- Experience in SIU (Special Investigations Unit) or Insurance Company quality assurance or fraud preferred
- Certified Fraud Examiner preferred
Responsibilities
- Monitors QMS procedures, work instructions, and job aids. Provides first level review for changes.
- Supports problem-solving solutions for system issues.
- Provides expertise for implementing, deactivation, monitoring, quality assurance, and reporting of prepay edits.
- Facilitates meetings and coordinates presentations.
- Tracks and analyzes data and reports for prepay committee edit effectiveness; creates presentations.
- Assigns incoming and outgoing external contractor communications; monitors completion of requests.
- Researches prepay and post-pay record questions. Reports quality assurance for appeal requests, recalculations, and redeterminations.
- Schedules coordination of ad hoc calls with external contractors or law enforcement; takes minutes.
- Reviews and comments on Medicare JOAs.
- Creates templates and content for the external contractor annual fraud and abuse training.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
