Intermountain Health Looking for Auditor Senior – Select Health at Lone Tree, CO  Full Time

Job Description:

The Senior Auditor position at SelectHealth provides auditing checks and recommendations to customer service operational areas within the organization. This may include either claims payment or customer service review. The Auditor and Senior Auditor job descriptions are used by the Phone Auditing Team and the General Auditing Team.

**This posting is intended for caregivers involved in an acquisition. Only applicants involved in the acquisition will be considered at this time.**

The Phone Auditing Team audits all the calls that come into Select Health and requires the staff to have a broad range of knowledge of what the various department do. This includes the Phone HBS teams for all lines of business (commercial, self-funded, individual, Medicaid and Medicare) and other departments (Member Advocates, Appeals, Central Support, Enrollment, Healthy Connections, Small Employer/Individual Sales, Medicare Inquiry Sales, Order Of Benefits Team, Pharmacy, Premium Billing, Provider Development, Receptionist, Recoveries, Subrogation, UM Intake). The Auditors assess the phone team’s accuracy and customer service delivery and assign a score that is used to provide performance feedback to the phone team. The Phone Auditors also certify all new hires to ensure they are ready to take calls independently and providing supervisor customer service, which directly affects the customer service survey scores for Select Health.

The General Auditing Team audits 2% of all manually paid claims and .5% of all system paid claims. On average, this represents over 3,600 audits every month. The Auditors assign an accuracy score to each claim they audit. The General Auditors certify all new hires along with all the processors who are passing off on specialty claim types (Medicare, Medicaid, adjustments, CAU, clinical editing/modifiers, COB, Dental, ortho, DME, ER/urgent care, inpatient, mental health, out of network providers, rehab, self-funded, restricted providers). They also audit including Enrollment, Loggers, Order of Benefits Team, Provider Development, Recoveries, ComCom, and Pharmacy direct member reimbursements for various teams on a monthly basis. Auditors are assigned to follow changes made to documentation and processes to educate auditors and to provide a unique point of view to the decision makers.

Senior Auditors are assigned the following duties:

• Conducts random customer service audits based on department standards and conducts monthly audits of assigned specialty areas with a high level of accuracy. Reports accuracy findings to department leads/management.
• Evaluates audits and/or certifies all new employees in customer service or claims payment. Conducts focused audits as needed or requested by management and internal audit. Performs second review process to review errors called by auditors for accuracy.
• Develops and provides training to teams on the identified error trends as needed. Meets with trainees as needed to provide coaching and constructive feedback.
• Acts as a resource to all needed departments and personnel to provide information regarding plan guidelines, benefits clarifications and benefit adjudication rules and is available as a resource for all HBS’s with claims processing or customer service related questions.
• Redesigns and implements audit criteria and reporting format as needed to meet company goals.
• Analyzes audit findings and recommends, develops, trains, and implements process changes that would result in improved accuracy and greater consistency of benefit administration.
• Documents and distributes audit criteria and policy.
• Coordinates efforts with the Training team to ensure that training is consistent with policy and plan administration guidelines.
• Presents and participates in various meetings, projects and Continuous Quality Improvements that relate to changes in policy and procedure and quality improvement.
• Reports quality audits, conducts audit trend analyses, targets company training needs and areas for process improvement; recommends the implementation of processes and training that improve quality and accuracy, has a positive financial impact and assists in meeting the company accuracy goals.

Minimum Qualifications

• Bachelor’s degree from an accredited institution in a business-related field and one year as a Level III of Health Benefits Specialist or Claims Processor OR four years of experience in health insurance which could include customer service, claims processing, or auditing
• Demonstrated Intermediate level proficiency with word processing, spreadsheets, and databases.
• Demonstrated attention to detail skills and able to work with minimal supervision.

Preferred Qualifications

• Technical background in claims specialties.
• Broad knowledge of managed care.
• Excellent skills in writing and oral communication with the ability to interact effectively with all levels of employees and management.
• Effective negotiation and problem-solving skills.
• Leadership ability within the team.
• knowledge and experience of Continuous Quality Improvement principles.

Physical Requirements:

Hearing/Listening, Manual Dexterity, Seeing, Speaking

Anticipated job posting close date:

11/25/2023

Location:

Benefits Administrators

Work City:

Lone Tree

Work State:

Colorado

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$23.94 – $37.69

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our, and for our ; and our commitment to.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Our facilities do not discriminate against any person on the basis of race, color, national origin, disability, or age in admission or access to, or treatment or employment in, its programs, services or activities, or on the basis of sex (gender) in health programs and activities