Remote Audit Senior Consultant

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Posted 13 days ago United States Salary undisclosed
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Job Description

The CSI Companies is actively seeking a Remote Audit Senior Consultant for our well known client, an accounting organization and one of the largest professional service networks in the world.
The CSI Companies understands that an attractive benefits package is important for recruiting above-average candidates. While on contract, we offer a benefits package that includes weekly pay, direct deposit, multiple healthcare plans (Vision, Dental, Disability options, Holiday Pay, & Paid Time Off) if eligible.
Schedule: Standard business hours; Full Time. Must be able to work 8AM-5PM EST.

This is a two month contract position.
Job Details:
Senior-level resource that has knowledge and background of claims processing, including the identification of end-to-end processes and controls related to:
  • Enrollment / Plan & Provider Configuration: Processes related to the plan and provider load (fee schedule and capitation), member enrollment, and provider credentialing.
  • Dental operational processes in scope are the following: file transfers between load systems and claims adjudication platforms, Claims System Configuration: Processes to configure claims adjudication rules, including the review, approval, and implementation; interface between claims adjudication platforms and data feeds; Data transfers for EOB and EOR.
  • Claims Processing / Quality Assurance (QA): Processes related to claims processing, including claim intake, pre-and post-pay, and QA processes to evaluate claims accuracy. Governance and Oversight: Processes related to the overall governance and oversight of claim adjudication for dental claims, including audit / monitoring.
This is a remote, work from home position. You can be located anywhere in the United States.

This is a remote, work from home position. You may be located anywhere within the US.