Auditor II - Data Mining

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

Responsibilities

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.

Qualifications

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.