Position Purpose: The Auditor I performs internal audit reviews. It ensures accurate payment for all claim types and verifies that the provider demographic information is loaded correctly in accordance with the Arizona Health Care Cost Containment System and the Centers for Medicare and Medicaid services requirements, rules, regulations and contract agreements.
Responsibilities: The Auditor I assures the quality of work within the organization by performing random quality audits of claims processed for one audit type or Line of Business. Performs audits on provider information and\or Contracts. Researches root cause of claim issues, determines corrective action to resolve it, communicates and documents findings. Applies new information (e.g. AHCCCS policies, AHCCCS encounter changes, Medicare procedures and processes, etc.) to the audits. The Auditor I analyzes and documents audit results by tracking and trending audit results and report findings. Identifies process improvements opportunities. Supports the audit needs of the organization by completing ad-hoc analysis and reports upon request. Performs other duties as assigned by completing other tasks as assigned to assist with operations of the internal department and other functional areas.
Education / Experience / Other Requirements
Years of Experience:
Work Related Experience:
- Strong experience on different payment methodologies
- Experience on MS Access, Excel, Word and Power Point
- Experience on analyzing data and problem solving
- Effective communication