Healthcare Audit Analyst (Hybrid)

Cape Cod Healthcare•Hyannis, MA

6d•Hybrid

About The Position

The Healthcare Audit Analyst will be responsible for developing systems and procedures for government audits, analyzing audit data, and presenting findings to senior management. This role requires specific knowledge of Medicare, Medicaid, and commercial payer audit processes, as well as effective communication with various internal and external stakeholders. The analyst will identify opportunities for performance improvement, coordinate activities with external partners, and recommend process enhancements to achieve efficiency and quality gains. Proficiency with audit tools and systems, including Decipher, is expected. The position also involves coordinating provider education and providing feedback to management on audit status.

Requirements

Associate’s or bachelor’s degree in Business or related field, or a combination of education and work experience.
One (1) to three (3) years of progressively more responsible healthcare experience.
Excellent interpersonal, problem solving, and critical thinking skills are required.
Excellent PC skills with a strong emphasis on the Outlook suite of products are required.
Excellent verbal and written communication skills are required.
Working proficiency with all systems and applications including Decipher and client tools.

Nice To Haves

Experience with hospital information systems preferred.
Prior experience with analysis of government audits are a plus.
Specific knowledge of Medicare Medicaid and commercial payer audit processes and time frames.

Responsibilities

Develops systems and procedures for all government audits, gathers, compiles, organizes and documents relevant audit information.
Analyzes, consolidates and interprets audit data.
Presents audit findings and all other relevant information to Senior Management, and/or the Audit Committee on an as needed basis.
Ensures compliance with all corporate standards and audit regulations as well as all CMS and commercial requirements.
Delegates assignments relating to the appeals process to appeal representatives and technical staff.
Communicates with/educates external entities including the Centers for Medicare and Medicaid Services, Office of Inspector General, commercial payers, appellants and their authorized representatives.
Communicates effectively verbally and in writing with Director and senior leadership, peers, departmental staff, and various corporate support departments.
Communicates effectively verbally and in writing with external business partners including vendors, payer representatives, Recovery Audit Contractors (RAC), Qualified Independent Contractors (QIC) and Medicare/Medicaid representatives.
Communicates effectively verbally and in writing with our customers including the Centers for Medicare and Medicaid Services (CMS), providers, and beneficiaries.
Identifies opportunities, using Medicare policies and procedures, claims processing procedures and related data processing systems, to improve overall performance.
Coordinates activities and exchange of information with external business partners.
Recommends, coordinates and initiates improvements to the process to achieve efficiency, cost reduction, productivity, and quality gains.
Effectively utilizes audit tools, proprietary reports, tools and systems required to perform duties.
Coordinates provider education activities.
Provides feedback to management on the status of audits in their section to ensure the department contributes toward the department meeting and exceeding all performance standards.
Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management.
Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.