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G&A Auditor II - Eagan, MN - P...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Eagan, MN
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS2719

G&A Auditor II - Eagan, MN - PS2719

About the Job

Description

G&A Auditor II

*Location - Eagan, MN

Responsible for post completion examination of grievances and appeals in multiple states.

Primary duties may include, but are not limited to:

  • Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards.
  • Reviews case to assess whether it was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties. 
  • Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review.
  • Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation.
  • Assists management in process improvement strategies to achieve business objectives.
  • Prepares audit findings and recommendations for G&A associates and management on a monthly basis.
  • Identifies and communicates error trends to improve overall quality of enterprise G&A team.
  • Associates at this level handle routine to complex audits and function as subject matter experts.

Qualifications

- Requires high school diploma or equivalent (GED).

- 3+ years experience including a minimum of 1 year related experience in an audit capacity (preferably in healthcare or insurance sector) with consistent above target performance.

- Claims processing experience is required.

- Proficiency in Microsoft Word, Excel and Outlook is required.

- Working knowledge of insurance industry and dental terminology preferred.

- Detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines.

- Ability to acquire and perform progressively more complex skills and tasks in a production environment or any combination of education and experience which would provide an equivalent background.

- Related quality auditing experience is preferred.

- Medicaid and Medicare knowledge is preferred.

- WDS, CLEAR, DDS experience is preferred.

EOE.M/F/Disability/Veteran

 

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