Internal Provider Auditor @ Arcadia

Internal Provider Auditor

Posted on 12/14/2022

INACTIVE

Locations

Rockford, IL, USA • Remote

Experience Level

Entry

Junior

Mid

Senior

Expert

Requirements

Minimum 3 years of experience in the healthcare or managed care industry, including claims/reimbursement experience, professional analytics-related experience and experience working on/managing major projects
Advanced to expert proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access
Able to problem solve, exercise initiative and make low to medium level decisions
Thorough understanding of current federal, state and local healthcare compliance requirements
Ability to meet deadlines and prioritize tasks; collect, correlate and analyze data
Ability to work independently with minimal supervision and as part of a team
Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player
Effective written and oral communication
1-3 years auditing experience in the healthcare industry
Bachelor's degree in healthcare informatics, business administration, or related field, or equivalent in experience and education
Ability to give constructive feedback and coaching

Responsibilities

Intermediate knowledge on the provider operations department processes
Novice understanding of provider entry into internal software and access database
Novice knowledge of contracts and claims processes
Consistently performs daily, weekly, monthly audits
Conducting routine monitoring and audits of providers within the internal software
Conducting quality audits on the provider operations department's entries of providers
Auditing monthly rosters as entered by provider operations
Understanding and staying current with client contract criteria and requirements in relation to the providers
Serving as an advanced resource and providing education to the provider operations team
Monitoring internal and external processes to detecting any practices that, either directly or indirectly, result in fraud, abuse or waste that results in unnecessary costs
Running access queries as needed for administrative purposes
Assisting claims auditors and contractual compliance auditors in additional compliance and auditing responsibilities
Consistently exercising independent judgment and discretion in matters of significance
Other duties and responsibilities as assigned

Based on the evolving situation with Covid–19 we are mostly remote, this includes the hiring process. We are in the process of moving to a hybrid of onsite and remote with some positions remaining 100% remote.

Why This Role Is Important To Arcadia

As an Internal Provider Auditor, you will ensure the accuracy of the provider set ups in the internal software and access database based off client contracts. This role will be responsible for providing results and education to the Provider Operations team.

What Success Looks Like

In 3 month

- Intermediate knowledge on the provider operations department processes

- Novice understanding of provider entry into internal software and access database

- Novice knowledge of contracts and claims processes

- Consistently performs daily, weekly, monthly audits

In 6 months

-Independently create internal quality audits

- Provide feedback to provider operations department

- Report audit findings to department managers for coaching, mentoring and tracking of audit percentages

In 12 months

- Intermediate understanding of provider contracts.

- Identify the need for higher level system enhancements as report requirements evolve and/or change.

- Bring forward new ideas, audits and processes.

What You’ll Be Doing

Conducting routine monitoring and audits of providers within the internal software
Conducting quality audits on the provider operations department’s entries of providers
Auditing monthly rosters as entered by provider operations
Understanding and staying current with client contract criteria and requirements in relation to the providers
Serving as an advanced resource and providing education to the provider operations team
Monitoring internal and external processes to detecting any practices that, either directly or indirectly, result in fraud, abuse or waste that results in unnecessary costs
Running access queries as needed for administrative purposes
Assisting claims auditors and contractual compliance auditors in additional compliance and auditing responsibilities.
Consistently exercising independent judgment and discretion in matters of significance
Other duties and responsibilities as assigned

What You’ll Bring

Minimum 3 years of experience in the healthcare or managed care industry, including claims/reimbursement experience, professional analytics-related experience and experience working on/managing major projects
Advanced to expert proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access
Able to problem solve, exercise initiative and make low to medium level decisions
Thorough understanding of current federal, state and local healthcare compliance requirements
Ability to meet deadlines and prioritize tasks; collect, correlate and analyze data
Ability to work independently with minimal supervision and as part of a team
Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player
Effective written and oral communication

Would Love For You To Have

1-3 years auditing experience in the healthcare industry
Bachelor’s degree in healthcare informatics, business administration, or related field, or equivalent in experience and education
Ability to give constructive feedback and coaching

What’ll You Get

Learn the life of a Contract Management firm with Independent Physician Associations across Illinois
Encouragement to bring ideas to the table
Be an integral part of a desired team within Arcadia’s Value Based Services.
Expand your claims processing knowledge to the “behind the scenes” aspect
Opportunity to be part of a team creating automated processes to drastically improve healthcare
Extraordinary and flexible work environment and culture
Amazing benefits package including flexible time off
Receive cash compensation with health, dental, and other benefits
Be a part of a mission driven company that is transforming the healthcare industry by changing the way patients receive care
A flexible, remote friendly company with personality and heart
Employee driven programs and initiatives for personal and professional development
Be a member of the Arcadian and Barkadian Community

About Arcadia

Arcadia.io helps innovative healthcare systems and health plans around the country transform healthcare to reduce cost while improving patient health. We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time. We are passionate about helping our customers drive meaningful outcomes. We are growing fast and have emerged as the market leader in the highly competitive population health management software and value-based care services markets, and we have been recognized by industry analysts KLAS, IDC, Forrester and Chilmark for our leadership. For a better sense of our brand and products, please explore our website, our online resources, and our interactive Data Gallery.

This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia’s custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

201-500 employees

Website

Energy tech company

Company Overview

Arcadia's mission is to stop climate change by breaking the fossil fuel monopoly. Their technology is lighting a cleaner path forward for everyone, from everyday consumers and small businesses to the innovators building the next generation of energy products.

Benefits

Competitive compensation and paid time off
Comprehensive medical, dental, vision, and FSA plans
Paid parental leave for everyone
Remote work opportunities
Professional development and ongoing feedback
Company stock options and 401(k)
Snacks, beverages, and regular lunches in the office
On-site gym, new parent, and wellness rooms in DC
Commuter benefits and secure bike storage
100% clean energy match for all employees

Company Core Values

Build for good
Build for all
Build with urgency
Build for simplicity
Build togethere