Cost Management Auditor

Position Code: 334b

Department:  Quality Assurance
Location: Columbus, Ohio
Immediate Supervisor:  Pam Hackler
Status: Exempt
Posted: May 01 2017

Essential Functions of Job:

• Review health, vision and dental claims by applying HealthSCOPE Benefits’ audit program to a statistically valid sample of claims • Review claims for erroneous payments • Detect and document inappropriate procedures • Detect instances of fraud and abuse • Identify and assist with improvements of teaching aids such as training handbooks, demonstration models, multimedia visual aids, computer tutorials and reference works within the Training Department • Monitor and evaluate the quality of procedural improvements • Maintain knowledge of all pricing techniques and procedures for customer base Provide monthly statistical reporting of results • Provide (at a minimum) monthly feedback to the Cost Management Department based on a trend analysis for the purpose of training. • Perform other related duties as assigned • Ability to report to the office

Qualifications:

• College degree preferred, experience considered in lieu of degree • Effective organizational and prioritization skills • Excellent oral and written communication skills • Basic knowledge of Microsoft Office software applications (Word, Excel, Outlook, Access) • Ability to work in a fast paced multi-tasking environment • Strong interpersonal skills with ability to function as a positive team member • Ability to travel • Ability to read, comprehend and apply contract information, certification information and benefit manuals • Strong mathematical background for calculating Claim Audit Scores, claim pricing, etc. • Working knowledge of benefit design and software programming is a plus • 2-3 years experience in Hospital based pricing preferred

 

The Company considers applicants without regard to race, color, national origin, sex, religion, mental or physical disability, marital status, age 40 years and over, sexual orientation or gender identity, veteran's status, or other characteristic protected by applicable law.

Applications for this vacancy will be received for 3 working days after the Posted date from Employees of HealthSCOPE Benefits with more than one year of service.

Applications for this vacancy will be received for 10 working days after the Posted date from External Applicants.