Auditor/Investigator II at Qlarant

Us, West Papua, Indonesia -

Full Time

Start Date

Immediate

Expiry Date

08 Apr, 26

Salary

0.0

Posted On

08 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Healthcare Investigation, Quality Assurance, Data Analysis, Problem Solving, Communication, Meeting Facilitation, Research, Presentation Skills

Industry

Information Services

Description

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities. Best People, Best Solutions, Best Results Job Summary: Monitors the processing and reconciliation of incoming electronic medical records, importing of prepay claims and records, and generating other operation reports related to process of prepay claims. Supports research of prepay and post-pay record questions as well as research and return of misdirected documents. Essential Functions: * Monitors QMS procedures, work instructions, and job aids. Provides first level review for changes. * Supports problem-solving solutions for system issues. * Provides expertise for implementing, deactivation, monitoring, quality assurance, and reporting of prepay edits. * Facilitates meetings and coordinates presentations. * Tracks and analyzes data and reports for prepay committee edit effectiveness; creates presentations. * Assigns incoming and outgoing external contractor communications; monitors completion of requests. * Researches prepay and post-pay record questions. Reports quality assurance for appeal requests, recalculations, and redeterminations. * Schedules coordination of ad hoc calls with external contractors or law enforcement; takes minutes. * Reviews and comments on Medicare JOAs. * Creates templates and content for the external contractor annual fraud and abuse training. Level of Supervision Received: Plans and arranges own work; works with manager to prioritize projects. Education (can be substituted for experience): Minimum Bachelor's Degree required Work Experience (can be substituted for education): 2 - 4 years of experience required; 5 - 7 years preferred Healthcare Investigation experience required; Medicare experience preferred. Certification(s): Certified Fraud Examiner preferred Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Responsibilities

The Auditor/Investigator II monitors the processing of electronic medical records and supports research related to prepay and post-pay claims. They also track data for prepay committee effectiveness and facilitate communication with external contractors.