Change Healthcare Contract Compliance Auditor in Topeka, Kansas
Overview of Position The Contract Compliance Auditor for Carve Out (Implant) will work independently and perform implantable medical device review audits. The successful candidate will demonstrate understanding of implant claims reimbursement methodologies, contract language, and health care revenue cycle. They will also possess working knowledge of manufacturer and/or FDA published information which meet current federal/payor policy guidelines for reimbursement. They will be capable of adapting to multiple audit criteria and requirements for a variety of clients.
What will be my duties and responsibilities in this job?
Analyze provider contracts and apply analysis to claims review
Review claim details and validate healthcare payments to identify implant overpayments
Utilize client criteria and guidelines; state and federal payment and auditing regulations; Food and Drug Administration (FDA) classifications; medical device/implant manufacturer information; and internal resources to conduct Carve Out audits
Professionally write and document audit determinations in internal auditing processing application using client specific requirements and examples
Navigate claim audit processes utilizing internal client specific workflows
Additional responsibilities or tasks as determined by supervisor/manager
What are the requirements needed for this position?
Bachelor’s degree from accredited college/university
Minimum of one year experience in healthcare claims review, healthcare contract and policy analysis, and claim adjudication
Demonstrate proficiency in interpreting healthcare contracts
Demonstrate knowledge of Bill Types, Discharge Status Codes, Revenue Codes, CPT, HCPCS, and ICD-10
Demonstrate knowledge of medical terminology, ability to identify implantable medical devices documented on itemized bills and in medical records, and how those devices are potentially used in various clinical procedures
Display strong analytical and mathematical skills
Able to prioritize tasks, adhere to deadlines, and exhibit strong organizational skills and attention to detail
Demonstrate professional writing skills, effective communication, and ability to work well with a team
Demonstrate capability to adapt to a variety of auditing criteria and requirements for multiple clients
Demonstrate ability to effectively implement feedback given regarding audits and audit processes
What other skills/experience would be helpful to have?
Knowledge of medical terminology and general understanding of surgical procedures
Exhibit proficiency in the use of software including, but not limited to, Microsoft applications; proprietary clinical audit programs; and equipment/hardware related to job responsibilities
What are the working conditions and physical requirements of this job?
General office demands
How much should I expect to travel?
None at the moment. Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.
Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!
COVID Vaccination Requirements
We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.
Equal Opportunity/Affirmative Action Statement
Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.
If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to firstname.lastname@example.org with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.
Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.
California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) .
Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.
Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.