- Under direct supervision, audit standard reports, smaller/lower profile project-based routines and identify over and under payments of claims.
- Scope may include auditing paid claims; determining whether an overpayment exists; duplicate payments; identifying incorrect contract or contract rates; data mining.
- Enter the claim into Cotiviti system accurately and in accordance with standard procedures.
- Work on less complex/medium standard audit reports with support and may include the review and documentation of claim potentials identified by Auditors and Sr. Auditors.
- Utilize with increasing proficiency, proprietary reports, tools, and systems required to perform duties.
- With moderate guidance and direction, timely executes assigned standard reports and updates.
- Working proficiency with all systems and applications including Decipher and client tools.
- Maintain production goals and quality standards set by the audit for the auditing concept.
- Works to meet the expected level of quality and quantity (i.e., fees per hour, vendor/project volume completion, claims written) determined for the audit.
- Respond to client/vendor disputes or internal QA for claims written.
- Provide verification of claims validation, in concise written and oral manner.
- Build a personal proficiency around transaction types, client contracts/vendor agreements, and client data with understanding of how to identify potential over/under payments.
- Complete all responsibilities as outlined on annual Performance Plan.
- Complete all special projects and other duties as assigned.
- Must be able to perform duties with or without reasonable accommodation.
Qualifications
- Bachelor's Degree in Finance, Accounting and/or Business Administration, or at least four years of equivalent experience required
- Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred
- Strong interest in working with large data sets and various databases
- Retail industry experience desired
- Excellent verbal and written communication skills
- Self-motivated and driven to succeed
- Must have strong English speaking and writing skills