Auditor Auditor …

Exl Company
in Pembroke Pines, FL, United States
Permanent, Full time
Be the first to apply
Competitive
Exl Company
in Pembroke Pines, FL, United States
Permanent, Full time
Be the first to apply
Competitive
Auditor
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  • Auditor II - DME Job Location US | US-FL-Miramar ID 2019-7137 Group SCIO Healthcare Analytics Type Regular Full-Time
  • Overview EXL/ SCIO Health Analytics is looking for a motivated Auditor II for our Miramar, FL location. This candidate should have experience in DME Medical Records and Billing.

    The Auditor II position is to assist SCIO Healthcare clients in controlling healthcare costs by performing audit reviews to determine if correct payments were made to providers. 

    Responsibilities
    • Perform an extensive review of client accounts to determine if correct payments were made to providers.
    • Accurately reprice complex claims utilizing multiple client claims systems to perform the tasks.
    • Identify work files to be audited through a query process.
    • Review provider contracts/fee schedules, to determine correct payment methodology.
    • Documentation of audit findings to be shared with client.
    • Evaluate current procedures for efficiency and accuracy.
    • Recommend solutions for process improvements.
    • Will perform other duties as assigned.
    Qualifications
    • High School Diploma.
    • 5-7 years of Medical Claims Processing Experience.
    • Experience with Processing complex medical health claims. 
    • Knowledge of CMS Pricing Guidelines.
    • Knowledge of Coding Methodolgies, Spreadsheet and Database Knowledge.
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