Client Audit Specialist in Woburn, MA at Beacon Health Options

Job Description

About The Position:

The Client Audit & Compliance Specialist conducts and supports internal audits and plan audits, and actively researches and facilitates a resolution when complaints are received from our Clients related to components reviewed during these audits. The incumbent will work closely with all Beacon Operational teams, including but not limited to Network Operations, EDI, Claims and Quality Control Management to ensure evidence produced and shared can be supported by policies and procedures. Through a solid understanding of behavioral health claims, the functions Beacon Health Options serves to our customers and how to both interact and present to clients, the Audit & Compliance Specialist will help Beacon Health Options fulfill its mission.

Position Responsibilities:

• Participate in client audits to ensure all evidence provided is in accordance with Plan, State and Federal regulations, and adjudication logic. (This includes CMS and direct clients.)
• May serves as the voice of Beacon Operational units for external audits
• Gathers and reviews material requested for audits to make sure they are complete, accurate and on time.
• Identifies and clearly communicates potential deficiencies or risks related to audits.
• Reviews results timely and come to independent conclusions that can be explained clearly and supported through data.
• Keeps management apprised of issues that may arise
• Assist in training new staff
• Other job duties as assigned

Position Requirements:

• Education: Bachelor’s Degree required

Relevant Work Experience:

• 2 years’ work experience
  • Must understand Behavioral Health Claims
  • Must understand standards of documentation usually associated with external audits, not limited to CMS or specific clients
  • Proficiency in Microsoft Excel and other Microsoft Office applications (Specifically OneNote and SharePoint)

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled