Auditor, Intermediate / Senior Auditor, Advanced

This is a fully remote position, open to applicants in United States.

📋 Description

• Design contract models for analysis and identify potential insurance reimbursement challenges through comprehensive examination of hospital claim data and associated documentation.

• Create and revise audit plans, pinpointing risk areas within hospital-payer contracts and methodologies for detecting those risks in claims data.

• Analyze insurance payments along with supporting documentation to assess payment accuracy and uncover reimbursement opportunities.

• Research, analyze, and compile summaries on underpayment issues, their financial implications, reimbursement trends, and suggested actions.

• Identify contractual and clinical reimbursement risk areas across both commercial and government payors.

• Develop specifications and procedures to recognize and address contractual, coding, and administrative underpayment risks.

• Conduct evaluations of zero-balance hospital accounts to detect underpaid inpatient and outpatient claims.

• Model reimbursement methodologies and create or maintain pricing documents utilized for calculating expected payments.

• Collaborate with data analysts and project teams to formulate, validate, and enhance pricing models and audit methodologies.

• Utilize technical tools and automation opportunities to boost audit efficiency and consistency.

• Present findings, processes, methodologies, and recommendations through clear documentation and reporting.

• Suggest enhancements to internal processes, audit methodologies, and client contract administration procedures.

• Investigate emerging reimbursement trends, regulatory shifts, and payer practices, and communicate insights to internal stakeholders.

• Senior Auditors may independently manage complex audit projects, identify new audit opportunities, serve as subject matter experts, mentor and train auditors, create training materials, and provide technical guidance and quality review.

⛳️ Requirements

• High School Diploma or equivalent is required.

• A Bachelor's degree in a related field or equivalent experience is preferred.

• Auditor (intermediate): At least 3 years of experience working with large healthcare data sets.

• Auditor (intermediate): At least 2 years of experience in research and analysis.

• Auditor (intermediate): At least 2 years of experience with managed care contracts and hospital reimbursement.

• Auditor (intermediate): At least 2 years of experience working with inpatient claims.

• Auditor (intermediate): At least 1 year of experience working with Medicare, Medicaid, and/or outpatient facility claims.

• Auditor (intermediate): At least 1 year of experience with contract modeling.

• Senior Auditor (Advanced): At least 5 years of experience working with large healthcare data sets.

• Senior Auditor (Advanced): At least 5 years of experience in research and analysis.

• Senior Auditor (Advanced): At least 3 years of experience with managed care contracts and hospital reimbursement.

• Senior Auditor (Advanced): At least 3 years of experience working with inpatient and outpatient claims.

• Senior Auditor (Advanced): At least 2 years of experience with contract modeling.

• Capability to convert complex contract language and healthcare data into actionable insights.

• Ability to work autonomously to resolve issues and propose technical solutions.

• Intermediate Excel skills, including complex formulas, functions, and pivot tables; senior level requires intermediate to advanced Excel, including lookups.

• Basic understanding of Access and SQL is preferred.

• Senior-level capability to lead intricate audits and reimbursement investigations.

• Senior-level ability to mentor, train, and develop staff.

• Strong organizational, analytical, written, and verbal communication skills.

• Exceptional attention to detail.

• Capability to perform work at a computer terminal for 6–8 hours a day.

• Occasional ability to lift and move materials weighing up to 20 lbs.

🏝️ Benefits

• Quality of life with a remote, predictable full-time schedule.

• Competitive compensation based on experience.

• Medical, Dental, Vision coverage and more.

• Long-term disability insurance and life insurance.

• Generous parental leave.

• 401K with company match.

• Certification and Tuition Reimbursement.

• Holidays and paid time off.