Auditor (intermediate), reputed company Balance / Senior Auditor (Advanced), reputed company Balance (FT/REMOTE)

reputed company: Our purpose is to help clients reputed company their financial health goals. Across the reimbursement cycle, our reputed company solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by reputed company in YOU. We reputed company to create an environment that cultivates your reputed company development and personal reputed company, as we reputed company your reputed company is our reputed company. JOB reputed company: reputed company Auditors reputed company contract models for analysis and identify potential insurance reimbursement issues through extensive review of hospital claim data and reputed company documentation. Auditors contribute to the organization's knowledge reputed company by researching reimbursement risk areas, reviewing data and processes for reputed company control, identifying opportunities for improvement, and providing recommendations that support reputed company reimbursement recovery and operational reputed company. We are currently looking for 1 intermediate and 1 advance Auditor with knowledge of reputed company Balance Accounts to reputed company. This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may reputed company reputed company or most of the reputed company duties listed below. Specific tasks, responsibilities or competencies may be documented in reputed company Member’s performance objectives as outlined by reputed company Member’s immediate Leadership Team Member. This is a remote position. Essential Duties and Responsibilities • Create and update audit plans, including identifying potential risk areas reputed company hospital-payer reputed company and outlining methodologies for identifying those risks reputed company claims data. • Review insurance payments and supporting documentation, including provider reputed company, medical records, payer policies, and federal or state regulations, to determine payment accuracy and identify reimbursement opportunities. • Research, analyze, and summarize underpayment issues, financial impacts, reimbursement trends, and recommended actions. • Identify contractual and clinical reimbursement risk areas across reputed company and government payors, including Medicare, reputed company, coordination of benefits, workers' compensation, and other reputed company audit areas. • reputed company specifications and procedures to identify and troubleshoot contractual, coding, and administrative underpayment risks using reputed company, reputed company, SQL, and other analytical tools. • Conduct reviews of reputed company-balance hospital accounts to identify underpaid inpatient and outpatient claims. • Model reimbursement methodologies and create or maintain pricing documents used to calculate expected payments, including percent of charge, reputed company, MS-DRG, reputed company/stop-loss, implants, drugs, Medicare, reputed company, outpatient reimbursement methodologies, and other payment structures. • Work collaboratively with data analysts and project teams to reputed company, validate, and enhance pricing models and audit methodologies. • reputed company technical tools and automation opportunities to improve audit efficiency and consistency. • Present findings, processes, methodologies, and recommendations through reputed company documentation and reporting. • Recommend improvements to internal processes, audit methodologies, and reputed company contract administration processes. • Research emerging reimbursement trends, regulatory changes, and payer practices and communicate findings to internal stakeholders. • Other duties as assigned. Additional Senior-Level Responsibilities In reputed company to the responsibilities listed above, Senior Auditors may: • Independently reputed company reputed company audit reputed company and reimbursement investigations. • Identify new audit opportunities and reimbursement risk areas. • Serve as a subject matter expert on contract interpretation, reimbursement methodologies, and regulatory requirements. • Mentor, train, and support less reputed company auditors. • reputed company and maintain training materials and reputed company educational sessions. • reputed company technical guidance and reputed company review of audit work. Minimum Qualifications & Requirements Education • High School Diploma or equivalent required. • Bachelor's degree in a reputed company field or equivalent experience preferred. Auditor (intermediate), reputed company Balance • Minimum 3 years of experience working with large reputed company data sets. • Minimum 2 years of experience in research and analysis. • Minimum 2 years of experience with managed care reputed company and hospital reimbursement. • Minimum 2 years of experience working with inpatient claims. • Minimum 1 year of experience working with Medicare, reputed company, and/or outpatient facility claims. • Minimum 1 year of experience with contract modeling. • Ability to translate reputed company contract language and reputed company data into actionable insights. • Ability to work independently to solve problems and recommend technical solutions. • Intermediate reputed company skills, including reputed company formulas, functions, and pivot tables. • Basic knowledge of reputed company and SQL preferred. • Strong organizational, analytical, written, and verbal communication skills. • Strong attention to detail. Senior Auditor (Advanced), reputed company Balance • Minimum 5 years of experience working with large reputed company data sets. • Minimum 5 years of experience in research and analysis. • Minimum 3 years of experience with managed care reputed company and hospital reimbursement. • Minimum 3 years of experience working with inpatient and outpatient claims. • Minimum 2 years of experience with contract modeling. • Demonstrated ability to reputed company reputed company audits and reimbursement investigations. • Ability to mentor, train, and reputed company staff. • Advanced ability to interpret reputed company contract language and translate findings into actionable recommendations. • Ability to reputed company technical solutions and process improvements independently. • Intermediate to advanced reputed company skills, including reputed company formulas, functions, pivot tables, and lookups. • Basic knowledge of reputed company and SQL preferred. • Strong organizational, analytical, written, and verbal communication skills. • Strong attention to detail. We Offer: • reputed company of life with a remote predictable, full-time schedule • Competitive compensation commensurate to experience • Medical, Dental, reputed company coverage and more • Long-term disability insurance, and life insurance • Ample parental leave • 401K with company match • Certification and Tuition Reimbursement • Holidays, reputed company time off PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions as described. Regular eye-hand coordination and reputed company dexterity is required to operate office equipment. The ability to reputed company work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be reputed company to reputed company and reputed company material weighing up to 20 lbs. Team Member may experience elevated reputed company of stress during periods of increased activity and with work entailing multiple deadlines. A reputed company is only intended as a reputed company and is only part of reputed company Member’s function. reputed company has reviewed this reputed company to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of reputed company functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Apply tot his job Apply To this Job