Provider & Claims Audit Analyst II-GP

Provider & Claims Audit Analyst II-GP Details: Major Health Care organization is currently seeking a qualified individual to be responsible for planning, executing, and reporting provider and financial claim audits for the Government Program division as necessary to comply with the NJ Medicaid contract. The incumbent in this role will act as a SME in developing the audit scope and work programs, executing the audit identifying issues and root cause, providing recommendations for corrective actions, and reporting findings. Responsibilities: Perform various analyses and audits relating to Medicaid/Medicare/Managed Care engagements. Prepare reports and may assist in presenting reports to senior management for State reporting. Accountable for identifying and assessing provider and claim audit processes and/or transactions including, but not limited to the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations. Pe rform risk assessment, audit planning, including determine appropriate audit period and scope of audit. Conduct all phases of the audit, including, fieldwork, analyze/review data, reporting of findings, making recommendations for improvement and other procedures as required. Conduct trend analysis; identifying top errors and improvements, identifying strengths, escalating areas of improvement and tracking best practices. Evaluate accuracy and effectiveness of Operations administration of benefits on all claim systems and lines of business. Assist/support in Government Programs enterprise-wide projects. Identify the scope of the project, assign auditors, ensure project completion is timely and accurate; and ensure that reports go to the appropriate personnel. Participate in internal/external meetings for purposes of calibrations, trends, best practice sharing, identify process improvements, and streamline benefit/reimbursement processes. Train, coach, and serve as a resource for juni or staff members. Perform assessments on quality audits: perform quality audits on less seasoned auditors (function as a work leader) Education/Experience: Requires Bachelors degree from an accredited college or university, preferably in Finance, Business Administration, or related field or equivalent work experience. Requires 2 - 4 years of relevant audit experience preferred (public accounting and/or internal audit) Experience in healthcare financial management, auditing and data analysis preferred. Source: Career Builder - Accounting

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