• Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements.
• Applies knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new overpayment recovery opportunities.
• Works with data miners, clinical staff, and stakeholders to identify new overpayment issues for each client.
• Tracks, and follows-up on results and recoveries
• Contributes new ideas for improving existing audit processes and audit queries. Works cohesively with the audit team.
• Develops, maintains, and ensures adherence to multiple project schedules

Experience in healthcare auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred.
Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience a plus preferred