The Provider Auditor provides verification of accurate provider contract intent, credentialing, demographic and reimbursement loading while working to drive improvement of manual processes and identification of setup and system errors. 

Key Accountabilities

• Perform and/or lead audits as defined by the annual audit plan
• Verify accurate system configuration against source data
• Review policies and procedures and ensure that the submission follows those business rules
• Act as a consultant for policy and procedure development
• Working understanding of health plan operational flows, reimbursement methodologies, system capabilities, credentialing requirements and an ability to work with Medica and other third party vendors to ensure processes support accuracy of demographic data and provider payments
• Provide feedback to staff on performance, along with tips to improve future results
• Analyze errors to identify trends and partner with leadership to ensure proper remediation to improve department quality 

Qualifications: 

• Bachelor's degree or equivalent experience in related field
• 5 years of healthcare experience beyond degree (auditing, data driven support, data entry, issue resolution, etc. helpful)

Skills and Abilities:

• Demonstrated proficiency in ad-hoc reporting using standard reporting tools
• Demonstrated competency in driving process improvements
• COPIS, COSMOS, Symfact and/or HealthRules knowledge preferred
• Issue Resolution experience
• Working knowledge of PC software (Word, Excel, Access, SharePoint, etc.)

This position is a Hub role, which requires an employee to occasionally come onsite to the designated office – Minnetonka, MN or Madison, WI – for applicable heads-up work. Frequency is determined by business need as decided by leadership.

The full salary range for this position is $60,000 - $102,800. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.