Audit Specialist I

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you’re starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE The Audit Specialist is responsible for reviewing medical claims to ensure payments have been processed correctly and in accordance with the Company’s policies and procedures. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments, and other irregularities.

ESSENTIAL JOB DUTIES Performs low to moderate audits of medical and dental claims as assigned by the Claims Quality Auditor Supervisor. Utilizes healthcare experience to identify any possible errors including but not limited to code edits, industry standard guidelines, provider contracts and benefit limitations Effectively utilizes audit tools. Reprocesses claims to apply appropriate payment based on audit findings; this would include individual claims and batch claim reprocessing. Creates and audits overpayment request letters. Researches and resolves escalated audit issues in a professional, accurate and timely manner Acts as a liaison with other departments regarding audits. Tracks and reports issues to resolve any underlying system and/or benefit inaccuracies Assist with monitoring of audit policies for accuracy and reports inaccuracies to management Assists in the development and implementation of policies and procedures related to audits Assists with the research and resolution of audit appeals Effectively handles multiple, concurrent, projects. Meets assigned deadlines and works under minimal supervision and with all levels of staff and management. Maintains required productivity standards. Maintains regular and predictable attendance Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice Works to encourage and promote Company culture throughout the organization Other duties as may be assigned

QUALIFICATIONS High School Diploma or GED required Associates or bachelor’s degree preferred Medical Coding or Medical Auditing Certification preferred In-depth knowledge of medical billing and coding including ICD-10, CPT4 Coding, HCPCS and medical terminology A minimum of four years’ work and/or educational experience in the healthcare industry In-depth knowledge of Medical Claims processing Knowledge of health insurance, HMO and managed care principles Critical thinking skills to build efficiencies Highly proficient in MS Excel and MS word Ability to find and willingness to suggest solutions with little or no guidance Strong Analytic skills Detail oriented and organized

PHYSICAL REQUIREMENTS Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS 401K (4% Match, Immediate Vesting) Accident insurance Competitive salary Critical Illness Insurance Dental Insurance Employee Assistance Program Flexible Spending Account Health & Wellness Program Health Savings Account Life & AD&D Insurance Long Term Disability Medical Insurance Paid Time Off Pet Insurance Short Term Disability Vision Insurance

PRE-EMPLOYMENT SCREENING Drug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.