Manager, Medical Audit Services

Lockton•Dallas, TX

About The Position

· Responsible for internal reference documents for Consultants and Health & Welfare teams, leading training sessions to educate new hire colleagues on medical audit offerings · Create and maintain audit templates such as audit notification letters, documentation request lists, report templates, sample workbooks, etc. · Responsible for performing and supporting complex audits of medical plans including but not limited to retrospective claims, operational, pre & post-implementation audits across all lines of business (Commercial, Medicare, Medicaid, Exchange, DSNP, EGWP) · Lead others in completing audits of medical plans · Serve as a subject matter expert in claim payment and compliance relative to client contracts, regulatory requirements and vendor health programs · Utilize results of initial claim data evaluations to select focused audit samples for review and response by the carrier; attend on-site audit to review claims and backup detail as necessary to determine accuracy of claim processing and payment · Work with carriers to determine root cause of errors, determine impact, and report audit results to clients of varying size and type (employers, health plans, etc) · Assist Consultants with discovery calls to explore potential clients’ interest in completing audits and developing solutions that meet their unique needs · Develop a tool to track audit status and results, developing key performance indicators and audit statistics/insights · Other responsibilities as deemed necessary to support the business #LI-SM3

Requirements

College degree (experience may be considered in lieu of college degree)
7+ years’ experience in medical claims auditing or consulting
Must demonstrate a high level of medical claims and health benefit administration knowledge under various lines of business (Commercial, Medicare, Medicaid)
Exceptional oral and written communication skills with high attention to detail
Ability to deliver results per an agreed upon timeline while keeping all stakeholders informed
Self-directed with strong project management skills
Ability to adjust to changing priorities without losing momentum toward overarching goals
Comfortable working collaboratively with others at all levels of an organization
Strong people leader with the ability to identify others’ motivators and potential for growth
Intermediate or expert level experience with Microsoft Suite (Word, Excel, PowerPoint)
Ability to travel as required for audits

Nice To Haves

Experience with SQL and/or Alteryx
Advanced degree in healthcare analytics or similar field
Experience in medical billing or coding

Responsibilities

Responsible for internal reference documents for Consultants and Health & Welfare teams, leading training sessions to educate new hire colleagues on medical audit offerings
Create and maintain audit templates such as audit notification letters, documentation request lists, report templates, sample workbooks, etc.
Responsible for performing and supporting complex audits of medical plans including but not limited to retrospective claims, operational, pre & post-implementation audits across all lines of business (Commercial, Medicare, Medicaid, Exchange, DSNP, EGWP)
Lead others in completing audits of medical plans
Serve as a subject matter expert in claim payment and compliance relative to client contracts, regulatory requirements and vendor health programs
Utilize results of initial claim data evaluations to select focused audit samples for review and response by the carrier; attend on-site audit to review claims and backup detail as necessary to determine accuracy of claim processing and payment
Work with carriers to determine root cause of errors, determine impact, and report audit results to clients of varying size and type (employers, health plans, etc)
Assist Consultants with discovery calls to explore potential clients’ interest in completing audits and developing solutions that meet their unique needs
Develop a tool to track audit status and results, developing key performance indicators and audit statistics/insights
Other responsibilities as deemed necessary to support the business