Auditor
1 day ago
Identify and Enter Claims
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. Can work on some simple/medium standard audit reports with support and may include the review and documentation of claim potentials identified by Auditors and Sr. Auditors.
Effectively Utilize Audit Tools
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.
Meet or Exceed Standards/Guidelines for Productivity
In addition to regular and predictable attendance, 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.
Meet or Exceed Standards for Quality
Achieve the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation.
Prepare Response to Client/Vendor Disputes
Respond to client/vendor disputes or internal QA for claims written.
Provide verification of claims validation, in concise written and oral manner.
Review Client Transactions
Build a personal proficiency around transaction types, client
contracts/vendor agreements, and client data with understanding of how to identify potential over/under payments.
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