Ltc Auditor II

job - , paid

Health Management Systems Incorporated
Windsor, CT
Closed
Posted 58 Days ago
Health Management Systems Incorporated
Windsor, CT
job - , paid
Posted 58 Days ago
Closed

Description

Job Information Health Management Systems, Inc. LTC Auditor II in Windsor Field Office, Connecticut HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcarenow and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others. We are seeking a talented individual for a LTC Auditor II who is responsible for the identification and recovery of client improper payments made to long term care healthcare providers. He/she is responsible for secure communication of audit results to the provider and effectively working with the provider throughout each phase of the review process. Essential Responsibilities: * Conduct financial audits of LTC provider paid claims utilizing appropriate sources of information, including eligibility, state and health plan billing manuals, and other related data files. * Interpret and apply federal and state Medicaid regulations, statutes, and policies pertaining to long term care. * Analyze provider records from multiple accounting software programs. * Identify improper payments relating to inaccurate payments, collections, and coordination of benefits. * Act as the primary liaison with their assigned long term care providers to obtain provider reports and patient records, answer provider questions, ensure timely response to audit findings, securely communicate audit results, and provide guidance throughout the review process. * Independently conduct entrance and exit conference calls with providers. * Responsible for contacting delinquent providers to follow up on repayment of all improper payments identified during the audit. * Manage 40 audits in varying phases within KPI goal parameters and meet all performance expectations, including audit production and revenue targets. * Perform more complex reviews. * Assist with the development and completion of pilot projects. * Effectively mentor Auditor I staff . * Responsible for status reporting to management. Non-Essential Responsibilities: * Performs other functions as assigned Knowledge, Skills and Abilities: * Strong analytical skills and an ability to overcome obstacles and resolve problems. * Ability to handle pressure and deadline oriented project demands as well as manage multiple initiatives. * Ability to multi-task, establish priorities, and meet revenue objectives. Detail oriented with the ability to manage multiple assignments simultaneously. * Must have excellent organizational and time management skills in order to manage multiple audits and meet or exceed KPI targets.Must have exceptional written and oral communication and interpersonal skills in order to build strong working relationships with both internal staff and assigned LTC providers. * Must be able to follow directives and adapt to shifting priorities as required. * Working knowledge of HIPAA privacy and Security rules. * Professional, confident, and have a positive work attitude. * Ability to perform well in team environment, with staff at all levels, to achieve business goals. * Ability to maintain a professional demeanor and appearance at all time. * Proficiency in PC based business applications including Microsoft Office (Word, Excel, Power Point, and Access). Work Conditions and Physical Demands: * Primarily sedentary work in a general office environment * Ability to communicate and exchange information * Ability to comprehend and interpret documents and data * Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.) * Requires manual dexterity to use computer, telephone and peripherals * May be required to work extended hours for special business needs * May be required to travel at least 10% of time based on business needs Minimum Education: * High School Diploma Required * Bachelors degree or equivalent related experience. Minimum Related Work Experience: * 1 years of experience as an LTC Auditor I * Medicaid and Medicare knowledge required Nothing in this job description restricts managements right to assign or reassign duties and responsibilities to this job at any time. Title: LTC Auditor II Location: Connecticut-Windsor Field Office Requisition ID: 190010GM EEO/Minorities/Females/Protected Veterans/Disabled.

Skills

auditing, accounting, government, financial audits, fraud, microsoft access, microsoft excel, microsoft office, microsoft word, data analysis, time management, security, reviews, regulatory filings, collections

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