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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.

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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 applyaccommodations@changehealthcare.com 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.

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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.