Corporate SIU Auditor in Grand Rapids, MI at Beacon Health Options

Date Posted: 10/22/2018

Job Snapshot

Job Description

About The Position:

The Corporate SIU Auditor will detect, investigate, remediate and refer to law enforcement as appropriate incidents of provider fraud, waste and abuse arising in connection with healthcare services.  Responsible for SIU provider audit procedures and assisting in the implementation of the Corporate SIU Plan and related activities under the direction of the Director, Corporate SIU.  Operates as a primary resource for Beacon Health Options (Beacon) and contact for fraud, waste and abuse investigation and prevention, provider monitoring and provider audit related activities.

Position Responsibilities:

  • Audit provider records to ensure they are documented and maintained to meet regulatory and contractual requirements and to identify any improper/potentially fraudulent, wasteful or abusive billing practices. Work with providers to develop corrective actions, including repayment of identified recoveries.
  • Write audit/investigative reports summarizing evidence, audit activities, and findings.  This includes compiling and organizing accurate case file documentation and calculation of overpayments. Make referrals of findings to clients, regulators, and/or law enforcement as appropriate and directed by the Director, Corporate SIU.
  • Offer training and technical direction for providers and assist the Director, Corporate SIU in the identification of training needs.
  • Participate on special projects, committees, and task forces and perform other duties as assigned. 
  • Foster and maintain positive relationships with representatives of Beacon’s core functions, policyholders, law enforcement, clients, providers, and the general public.
  • Serve as a role model for compliant behavior and integrity, consistent with the mission, vision and values of Beacon, and as an internal authority on applicable audit standards.
  • Serve as Beacon’s representative during formal proceedings when necessary.

Position Requirements:

  • Education: Bachelor’s degree in accounting, finance, management, healthcare, criminal justice or equivalent field preferred. A combination of education/experience will be considered for candidates with a bachelor’s degree in a field other than those listed above. The experience must be in addition to the Relevant Work Experience described below and in a similar capacity to the job duties of this position.
  • Licenses: Either Licensure or Certification is preferred, but not required. If degree is in healthcare, then current state licensure as results from the degree program, e.g., RN, LPN, Physician Assistant, or CRNP, etc. Certifications must be related to their professional training, to include: Association of Certified Fraud Examiners (CFE); Accredited Healthcare Fraud Investigator (AHFI); Certified Internal Auditor (CIA); or Professional Coding through AAPC (CPC) (CPC-H) CPC-P) or AHIMA (CCS) (CCS-P).

Relevant Work Experience:

  • Minimum of three years of experience in healthcare, accounting (public or private), or healthcare coding and auditing, with preference given to candidates with this experience in a managed care environment.  In addition, at least two years of experience is required in fraud and abuse and/or white collar crime investigations and two to three years of experience in healthcare claims preferred.

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

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