Audit Analyst I

Job Description

REQUIREMENTS

• Bachelor’s degree preferred. Health Services Administration, Business Administration, Accounting, Finance or related field are preferred
• Three (3) years in related field of claims processing, customer service, benefit policy interpretation or claims systems.
• Two (2) years BCBSM experience auditing or performing analytical assignments, benefit interpretation and customer service or working with the public preferred.
• Knowledge of NASCO/MOS claims processing, BCN/Facets, MEDCO, Medicare Advantage and BlueCard claims and knowledge of back-end data reporting preferred.
• Basic project management skills.
• Knowledge of generally accepted auditing principles and theories.
• General knowledge of Par Plan and/or Control Plan activities
• Excellent analytical, organizational, planning, verbal and written communication skills.
• Ability to analyze, investigate and organize ideas in recognizing, defining and formulating solutions to problems.
• Excellent interpersonal skills to effectively interface with all levels of BCBSM personnel, external auditors and customers.
• Proficient in current industry standard PC applications and systems (e.g. Word, Excel and Microsoft Office).
• Ability to work independently, within a team environment and handle multiple priorities.
• Other related skills and/or abilities may be required to perform this job.
• Must be able to travel to various BCBSM locations within and outside the state, and BCBSM plans.

RESPONSIBILITIES

• Plan, organize, direct and monitor audit coordination activities for external audits of small to medium ASC groups consisting of up to 200 claim samples.
• Coordinate Claims Recovery and Voluntary Employee Benefit Association (VEBA) and Control Plan audits; approximately 5 to 25 audits concurrently.
• Review and distribute questions from external auditors to appropriate departments and review the responses to validate their accuracy and completeness.
• Distribute questionnaires from external auditors and assist in compiling a corporate response. External auditor generally conducts off-site desk level reviews.
• Obtain claim documentation for all lines of business and claim systems and calculate claim payments or re-price claims samples.
• Follow-up on corrective actions (generally claim adjustments and recoveries) and report progress of recovery to external auditors and leadership in a timely manner.
• Other duties and responsibilities as may be assigned.

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