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Job Description

In accordance with company guidelines, performs random medical audits, target audits, re-audits, etc and audits for claims which are in excess of payment authority limits in assigned audit queues.

Listen to and view all recorded customer service calls within the MPS call center.

Ensures compliance with appropriate company policies, procedures, guidelines, and reporting requirements; Federal and state regulations; and timeliness of claims processing.

Utilize Excel, prepares tracking and trending written audit reports based on findings and communicate audit findings with appropriate leadership, with accuracy, and work with the MPS Call Center Manager/Supervisor/Team Lead and analyze the data for training purposes.

Identifies patterns, trends, and variances related to claims and calls and provides feedback to their Manager.

Maintains up-to-date working knowledge on regulatory requirements associated with billing and claims processing, as well as HIPAA guidelines/established Encryption policies and procedures.

Reviews Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) to determine proper category for benefit code determination.

Create training materials via PowerPoint, and other multiple media platforms as determined by management.

Participates in all aspects of the organization’s Compliance Program which may include assigning New Hire and Employee Annual Compliance training.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Skills and Requirements

Strong organizational and interpersonal skills

Excellent written and verbal communication skills

Detail oriented

Ability to multi-task and work independently

Qualifications

Qualifications:

Prior auditing experience is preferred

Knowledge of medical terminology

Knowledge of medical coding systems

Knowledge of Medicaid/Medicare Guidelines

Knowledge of billing rules and regulations.

Strong organizational and interpersonal skills

Excellent written and verbal communication skills

Detail oriented

Ability to multi-task and work independently

Bilingual fluency is a plus [English/Spanish]