EXL

Analyzes business data and runs outsourced operations

Auditor 2 - Data Mining

Claims AdjudicationConfirmed live in the last 24 hours

Full-timeUnited States$18.50 - $30 /hrIn-person

About the Job

Requirements

A high school diploma or equivalent is required.
A college degree or equivalent work experience is accepted.
Maintain OIG/GSA clearances.
Attention to detail.
Excellent written and oral communication skills.
Ability to adjust to shifting priorities and timelines using analytical and problem-solving capabilities.
Ability to learn, understand, and apply new technologies.
Knowledge of Centers for Medicare & Medicaid Services guidelines.
Strong knowledge of Healthcare Common Procedure Coding System, Current Procedural Terminology, and other coding methodologies.
Knowledge of spreadsheets, word processing, and databases.

Responsibilities

Review query output to identify potential overpayments and perform audits according to internal policies, regulations, and contractual agreements between insurers and providers.
Use medical claims knowledge and professional judgment to determine whether discrepancies exist and document findings using applicable standard documentation guidelines.
Follow step-by-step query documentation to validate overpayments.
When available, use claims systems to verify overpayments.
Document overpayments and non-overpayments in production systems, articulating clear reasons for claims determined not to be overpaid for research and quality assurance.
Meet quality and production standards.
Record production tasks and time in the format specified by management.
Communicate issues that could impede assigned work to management and work with management to resolve them.
Provide management with feedback on areas for improvement.

Desired Qualifications

One to two years of auditor experience.
One to two years of medical claims processing experience.

The Auditor II – DM (Data Mining) reviews the output of queries to identify potential overpayments and performs the audit following set internal policies and procedures in accordance with the regulations and set contractual agreements between insurers and providers. Exercises independent decision making and professional judgment, using medical claims knowledge on a regular basis. The Auditor I determines if a discrepancy exists and documents the findings using standard documentation guidelines as applicable.

*Base Pay Range: $18.50 - $30.00/hr

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

Attention to Detail

Excellent written and oral communication skills

Flexible during times of change - Adjust to shifting priorities and timelines through analytical and problem solving capabilities

Must be able to learn, understand, and apply new technologies

Knowledge CMS guidelines

Strong knowledge of HCPC, CPT and other coding methodologies

Spreadsheet, word processing, and database knowledge

Educational Qualifications:

High School Diploma or Equivalent Required

College Degree or Equivalent Work Experience

Maintain OIG/GSA clearances

Preferred Experience:

1-2 Years’ Experience Auditor

1-2 Years’ Experience with Medical Claims Processing

*The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.

Reviews output of queries for overpayments.

Follow Query Step-by-Step Documentation to validate overpayments.

If available, utilize claims system(s) to verify overpayments.

Document overpayments/non overpayments in production systems. Claims not overpaid should have clear reasons articulated for research purposes and quality assurance.

Meet quality and production standards.

Record production tasks and time into format outlined by Management.

Communicate to Management any issue(s) that would impede completion of assigned work.

Work with Management to ensure these issues are resolved.

Provide feedback to Management on areas of improvement.

EXL

Auditor 2 - Data Mining

About the Job

Requirements

Responsibilities

Desired Qualifications

About the Company

EXL

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