Lead Analyst, Configuration Oversight (Claims Audit)

Job description

JOB DESCRIPTION Job Summary Provides lead level analyst support for accurate and timely implementation and maintenance of audit programs. Also provides lead level analyst support for QA of post payment recovery concepts. Validates data housed on databases and ensuring adherence to business and system requirements as they pertain to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements critical to claim and payment accuracy. Facilitates end-to-end claim audits, maintains audit records, provides counsel regarding coverage amount/benefit interpretation within the audit process, monitors and controls backlog and workflow of audits, and ensures that audits are completed in a timely fashion and in accordance with audit standards. Initial primary audit focus will be on executing on a transplant audit across the organization Essential Job Duties: - Accurately interprets end-to-end business requirements, and confirms that outcomes meet specific state/federal requirements. - Creates reporting tools to enhance audit communications on configuration accuracy results and/or audit findings. - Writes complex ad-hoc r...