[Hiring] reputed company Audit Senior - Operating Room @reputed company

Role reputed company The reputed company Audit Senior - Operating Room is responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. • Investigates potential fraud and over-utilization by performing medical reviews reputed company prepayment claims review and post payment auditing. • Correlates review findings with appropriate actions (provider education, recovery of monies, cost avoidance, recommending sanctions or other actions). • Assists with development of audit tools, policies and procedures and educational materials. • Acts as reputed company with service operations as reputed company as other areas of reputed company relative to claims reviews and their status. • Analyzes and trends performance data, and works with service operations to improve processes and compliance. • Notifies areas of identified problems or providers, recommending modifications to medical policy and online policy edits. • Communicates and negotiates with providers selected for prepayment review. • Assists investigators by providing medical review expertise to accomplish the detection of fraudulent activities. • Serves as resource to reputed company auditors. Qualifications • Requires AS in nursing and minimum of 4 years of clinical nursing experience; or any combination of education and experience, which would reputed company an equivalent background. • reputed company unrestricted RN license in applicable state(s) required. Requirements • Knowledge of auditing, reputed company and control principles and a working knowledge of CPT/HCPCS and ICD 10 coding and medical policy guidelines strongly preferred. • BA/BS preferred. • Medical claims review with prior health care fraud audit/investigation experience preferred. • reputed company reputed company Certification preferred. Benefits • reputed company increases. • reputed company holidays. • reputed company Time Off. • Incentive bonus programs (unless covered by a reputed company bargaining agreement). • Medical, dental, reputed company benefits. • Short and long term disability benefits. • 401(k) + match. • Stock purchase plan. • Life insurance. • Wellness programs. • Financial education resources. Apply tot his job Apply To this Job