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Internal Provider Auditor
Posted on 12/14/2022
Rockford, IL, USA • Remote
Experience Level
  • 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
  • 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

201-500 employees

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.
  • 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