Auditor, Special Investigations

Blue Cross & Blue Shield of Mississippi • Flowood, MS

6d

About The Position

Healthy Careers Start Here At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle. The incumbent is responsible for conducting comprehensive audits of Network Providers (Institutional, Professionals and Allied) for compliance and to identify and remediate Provider fraud, waste and/or abuse. The incumbent collaborates with Management and the Provider Compliance team to implement proactive Provider billing monitoring designed to identify potential fraud, waste and abuse. The incumbent is responsible for collaborates with the Clinical Quality and Claims Operations Business Areas to identify and address fraud, waste and abuse and implement controls to address identified fraud, waste and abuse and quality issues.

Requirements

• A Bachelor’s Degree in Business or other health related field is required.
• Three (3) years audit experience required with experience in auditing Institutional providers or other related provider auditing is preferred.
• Healthcare experience preferred.
• Experience in interpretation of data analysis and analytical reporting is required.
• PC skills required to include the Microsoft Office Suite.
• Effective oral and written communications skills.

Nice To Haves

• Three (3) years audit experience required with experience in auditing Institutional providers or other related provider auditing is preferred.
• Healthcare experience preferred.

Responsibilities

• Conducting comprehensive audits of Network Providers (Institutional, Professionals and Allied) for compliance
• Identify and remediate Provider fraud, waste and/or abuse
• Collaborate with Management and the Provider Compliance team to implement proactive Provider billing monitoring designed to identify potential fraud, waste and abuse
• Collaborate with the Clinical Quality and Claims Operations Business Areas to identify and address fraud, waste and abuse and implement controls to address identified fraud, waste and abuse and quality issues

Benefits

• We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation.
• Our benefits program is among the best in the health care field.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees