Claim Auditor Payment Integrity (44544)

Neighborhood Health Plan of Rhode IslandSmithfield, RI

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Overview

Schedule

Full-time

Career level

Senior-level

Remote

On-site

Job Description

The Claim Auditor in Payment Integrity will address problematic and complex audit assignments to identify claim overpayments in accordance with established billing and coding parameters. Claim payment accuracy will be recognized through sound audit review methods and practices, including but not limited to; claim payment evaluation, medical chart review, claim payment data analysis and assessment of established organizational contractual parameters. Independently analyzes, extracts, refines, and interprets claims data for actionable insights. The Auditor uses self-directed, decision making and problem solving that directly impacts financial outcomes and results.

Duties and Responsibilities:

Responsibilities include, but are not limited to:

Investigate potential over-utilization by performing audits thought pre and post claim payment.
Initiate and verify claims adjustments, maintain audit documentation, and prepare savings reports.
Identify new audit areas through data mining and performing sample audits.
Develops reports and deliverables for management and communicates with all levels of stakeholders.
Provide recommendations and collaborate with Payment Integrity team on audit outcomes, identified issues, recommended modifications to clinical medical policies, billing and reimbursement guidelines, and online provider manual.
Serve as contact with all operational areas relevant to Payment Integrity audit decisions.
Represent company in internal and external meetings/conference calls when needed to discuss audit results or perform coding education.
Performs other duties as assigned

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FAQs About Claim Auditor Payment Integrity (44544) Jobs at Neighborhood Health Plan of Rhode Island

What is the work location for this position at Neighborhood Health Plan of Rhode Island?

This job at Neighborhood Health Plan of Rhode Island is located in Smithfield, RI, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.

What pay range can candidates expect for this role at Neighborhood Health Plan of Rhode Island?

Employer has not shared pay details for this role.

What employment applies to this position at Neighborhood Health Plan of Rhode Island?

Neighborhood Health Plan of Rhode Island lists this role as a Full-time position.

What experience level is required for this role at Neighborhood Health Plan of Rhode Island?

Neighborhood Health Plan of Rhode Island is looking for a candidate with "Senior-level" experience level.

What is the process to apply for this position at Neighborhood Health Plan of Rhode Island?

You can apply for this role at Neighborhood Health Plan of Rhode Island either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.