Internal Provider Auditor - Remote

Overview

The Internal Provider Auditor will ensure the accuracy of provider setups in internal software based on client contracts, providing results and education to the Provider Operations team.

In Short

• Conduct routine monitoring and audits of providers.
• Perform quality audits on provider operations entries.
• Audit monthly rosters submitted by provider operations.
• Understand client contract criteria related to providers.
• Monitor processes to detect fraud, abuse, or waste.
• Run access queries for administrative purposes.
• Assist claims and compliance auditors with additional responsibilities.
• Exercise independent judgment in significant matters.
• Other assigned duties.

Requirements

• Minimum 3 years in healthcare or managed care, including claims experience.
• Proficiency in Microsoft Office, especially Word, Excel, and Access.
• Problem-solving and decision-making skills.
• Understanding of healthcare compliance requirements.
• Ability to meet deadlines and analyze data.
• Work independently and as part of a team.
• Organized, self-motivated, and detail-oriented.
• Effective communication skills.
• 1-3 years of auditing experience preferred.
• Bachelor's degree in healthcare informatics or related field preferred.

Benefits

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