Sr. Auditor

Responsible for assisting and supporting in the evaluation, recommendation, establishment, implementation and analysis of new and improved production workflows, work processes for systems, reporting, and new products/programs to improve customer service levels and overall quality.

• Review of medical records
• Perform clinical reviews with knowledge of body systems, anatomy and physiology.
• Assist and support in the planning, coordination, developing and implementing of approved audit programs to enhance the overall efficiency of operational procedures, methods, controls and performance.
• Analyze, process and/or expedite operational transactions; this may include timely resolutions of problems.
• Participate in systems testing, develop procedures and controls and provide recommendations for the ongoing improvement of the updated process.
• Provide leadership team with status of projects, issue, communicate and recommend policy decisions to achieve project objectives.
• Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters, communications and graphics.
• Assist internal and external personnel by answering questions and supplying information.
• Develop and maintain effective working relationships with customers and partners.
• Conduct and oversee training of current and new staff.
• Review letters and reports of audit staff for accuracy and completeness.
• Complete special assignments and projects as assigned.
• Serve as back up to Team Leader as needed.

QUALIFICATIONS

• Bachelor’s degree in health-related field preferred.
• Four (4) years of experience in related field.
• Experience required in operational analysis, data analysis and problem resolution type activities.
• Current unrestricted state of Michigan Registered Nurse license required.
• Current Registered Health Information Administrator or Registered Health Information Technician for coding responsibility.
• Current Certified Pharmacy Technician for pharmacy audit responsibility.
• Thorough understanding of medical coding (CPT-4; HCPCS; ICD-9 or DRG) as it relates to audits.
• Ability to plan, organize direct and control projects.
• Excellent written and verbal communication skills.
• Ability to lead and contribute to process improvement projects.
• Working knowledge of PC applications and/or mainframe preferred.
• Other related skills and/or abilities may be required to perform this job.

Departmental Qualifications:

• Knowledge of Interqual criteria is preferred.