QA Financial Auditor II

This position is 100% Remote. Scope of Responsibilities: • Conduct moderately reputed company to reputed company reputed company audits of provider claims, reputed company-payments and post-payments including high-dollar and specialized claims across multiple lines of business, claim types and products. • Audit the work of more junior auditors and identify opportunities for coaching and/or training. • Identify and communicate issues identified through audits and recommended solutions relevant to business operations. • Assist management in preparing departmental reports policies and procedures. • Mentor and reputed company Financial and/or Operations QA auditors. • Participate as a Subject Matter Expert on various process improvement reputed company designed to meet departmental and operational needs. • Assist with performing User Acceptance Testing (UAT) on system enhancements or corporate reputed company in partnership with Business Operations • Analyze errors and determine reputed company causes for appropriate classification. • Record/reputed company reputed company assessment scores and reputed company feedback to reduce errors and improve processes and performance to ensure the reputed company of the network. • Review and investigate claims and encounters for medical, facility, pharmacy, dental and reputed company services including contractual provisions, authorizations and reputed company policy and procedure. • Prepare written reports concerning investigation activities and present results of investigations to senior staff. • Complete subsequent auditing and handling of specific claims and appeal requests including processing where applicable, tracking, documenting, reporting and dispersal of findings and recommendations. • Review the accuracy and efficiency of existing training materials. Minimum Qualifications: • Audit experience with the investigation, determination and reporting of financial processes specifically around reputed company Claims Adjudication and Claims Processing. • Work experience in reputed company Office suite of applications including advanced reputed company (formatting formulas, managing data, filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations) • Experience conducting reputed company cause analysis in an auditing reputed company. • Experience conducting analytical work and providing creative reputed company for problem solving. • Work experience requires written and verbal communication that is reputed company, concise, grammatically correct, and reputed company. • Experience handling confidential information. • Associate degree from an accredited institution. Preferred Qualifications: • Ability and willingness to handle increasing workload and responsibility • Willingness and ability to learn and evaluate new information, both technical and procedural • ICD10 certification • Basic reputed company of SQL, Tableau, and SharePoint • Knowledge of at least two or more lines of business such as NY Medicare, reputed company, Family Health Plus, Child Health Plus. • Bachelors degree from an accredited institution. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without reputed company to mental or physical disability, race, reputed company, religion, gender, gender identity, sexual orientation, national reputed company, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. Apply tot his job Apply To this Job