Provider Auditor in Latham, NY at Beacon Health Options

Date Posted: 7/21/2018

Job Snapshot

Job Description


The Provider Auditor will be part of the Provider/Network Audit team with responsibility for corporate wide audit. This audit will be conducted in both the Connects and Flexcare system. Incumbent must be a self-starter and able to multi task throughout the day.

About the Position:

  • Performs quality oversight of the Credentialing and Provider Data teams by conducting daily random event/provider file audits, following department workflow and established random sampling procedure. 
  • Utilizes Network Connects in conjunction with Flexcare and CAS.
  • Maintain expert and complete knowledge of the processes involved in entering data into the internal tracking database for all files audited.
  • Track and identify trends to recommend remedial action and/or changes in the established procedures.
  • Must understand the principles of Quality Improvement and demonstrate commitment to compliance and continuous improvement.
  • Ability to work in a production based environment and meet production goals. Incumbent must maintain minimum number of files reviewed on a daily basis as well as an industry standard refute overturn rate.
  • Ability to deal with complex issues while maintaining a flexible positive, cooperative demeanor.  Flexibility and adaptability to meet periodic changes in departmental needs.  Promotes direct, honest, open and timely communication.
  • Ability to work in a fast paced environment and prioritize multiple demands. Demonstrate exceptional organizational skills, capable of prioritizing responsibilities, multi task, detail oriented, and ability to work independently with limited supervision.
  • Ability to learn quickly and a keen eye for details, analytical and problem solving skills, the ability to withstand varying job pressures and to meet deadlines.
  • Displays flexibility in work assignments and a positive attitude.

 Position Requirements:

  • Education: A High School GED/ Diploma or equivalent is required.
  • Relevant Work Experience: Minimum of 3 years’ experience working in the health insurance industry. Six months experience in credentialing/provider data 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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