Internal Provider Auditor - Remote

Overview

As an Internal Provider Auditor, you will ensure the accuracy of the provider set ups in the internal software and access database based off client contracts. This role will be responsible for providing results and education to the Provider Operations team.

In Short

• Conduct routine monitoring and audits of providers within the internal software.
• Conduct quality audits on the provider operations department’s entries of providers.
• Audit monthly rosters as entered by provider operations.
• Understand and stay current with client contract criteria and requirements in relation to the providers.
• Monitor internal and external processes to detect any practices that result in fraud, abuse or waste.
• Run access queries as needed for administrative purposes.
• Assist claims auditors and contractual compliance auditors in additional compliance and auditing responsibilities.
• Exercise independent judgment and discretion in matters of significance.
• Other duties and responsibilities as assigned.

Requirements

• Minimum 3 years of experience in the healthcare or managed care industry.
• Advanced proficiency in Microsoft Office products.
• Able to problem solve and make decisions.
• Understanding of healthcare compliance requirements.
• Ability to meet deadlines and analyze data.
• Work independently and as part of a team.
• Organized, self-motivated, detail-oriented, and professional.
• Effective written and oral communication skills.
• 1-3 years auditing experience in the healthcare industry is preferred.
• Bachelor’s degree in healthcare informatics or related field is preferred.

Benefits

• Fully remote work environment.
• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan with employer match.
• Life and Disability insurance.
• Employee Assistance Program (EAP).
• Flexible Time Off.
• Paid parental leave.
• Resources for professional growth and development.