This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
The Audit Analyst will be responsible for conducting thorough audits of process, ensuring compliance with Regulatory Pricer Product standards and identifying areas of improvement.
Job Responsibility:
Perform details audits on operational processes and validate compliance with internal polies and external regulations
Analyze data and operational metrics to identify discrepancies, trends and areas of improvement
Conduct in-depth research of pricing issues, system related problems and policy and procedure challenges to confirm root cause. Recommend actions/resolutions
Prepare comprehensive audit reports, summarize findings and provide actionable recommendations to managements
Ensure adherence to regulatory and business requirements and internal controls
Identify areas of potential risk and develop strategies to mitigate them
Collaborate with varies departments to implement process improvements and enhance operational efficiency
Maintain accurate and up-to-date audit documentation and records
Provide training and support to staff on audit related matters
Support multiple audit projects, initiatives and tasks while adhering to deadlines
Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Requirements:
2 years of relevant experience or equivalent combination of education & work within healthcare payer or provider
Knowledge of healthcare reimbursement methodologies and acceptable billing practices
Knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards
Knowledge of claims adjudication process and interpret claim editing rules
Proficient in Microsoft Office, Word, Excel
Excellent written, oral and presentation skills and ability to communicate complex concepts
Nice to have:
Certified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge