Audit Analyst

☞ Evolent Health

View: 103

Update day: 30-05-2024

Location: Pune Maharashtra

Category: Health / Medical Care Human Resources

Industry: Healthcare

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Job content

Job title


Audit Analyst


Department


HPS - Claims Audit


Report To

NA


Work Location


Pune

It’s TimeForA Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Position summary

Evolent is looking for bright and energetic individuals to be a Claim Auditor & Quality Assurance Specialis

Essential functions

Ensure compliance with contract administration, demographic maintenance, and service level requirements through claim reviews and client appeals.
Conducts Audit-the-Auditor claim audits.
Support recoupment and recovery activities for claim overpayments.
Support request for funding and other financial related activities supporting claims adjudication.
Support business goals & system fixes by claim reviews, analyzing, identifying, and resolving issues.
Participate in documenting and prioritizing potential solutions to issues & fallout for system issues.
Establish and implement interim workaround solutions as needed and communicates to all impacted users.
Assist in establishing and communicating new and existing policy and procedures.
Facilitate discussions and solutions with matrix partners and acts as a subject matter expert.
Accountable for analyzing and measuring results of implemented policies, changes and system modifications.
Effectively handle multiple initiatives as the same time.
Effectively communicate across all levels of management and management personnel
Other duties as assigned

Key competencies/skill/success factors:

In-depth knowledge of medical billing and coding
Knowledge of health insurance, HMO and managed care principles
Strong leadership and management skills
Define and manage staffing needs including recruitment
Critical thinking skills to build efficiencies
Create and manage productivity reports
Create and maintain policy and procedures
Manage and execute projects
Excellent interpersonal, oral and written communication skills
Strong attention to detail and organization
Able to work independently; strong analytic skills
Strong computer skill


Qualification and Experience:

Required

Associate or Bachelor degree preferred.

Extensive experience in health insurance claims processing with a minimum of 3 to 5 years

HMO Claims or managed care environment preferred

Big plus

NA


Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position primarily works in a climate controlled based setting.The noise level and the work environment are moderately quiet. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines


Physical demand:

Include the physical demands of the job, including bending, sitting, lifting and driving. For example, while performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.

Why Join Evolent?

Named among Forbes’ 2014 America’s Most Promising Companies and Glassdoor’s 2015 Best Places to Work, Evolent provides an opportunity to work with top talent in an organization committed to career development. While we come from a variety of backgrounds, we pursue a singular mission: to change the health of the nation by changing the way health care is delivered

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Deadline: 14-07-2024

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