Audit Analyst I

Description

Classification: Non-Exempt

Level: Tier I

Pay Range: Depends on Experience level

Reports to: Audit Supervisor

JOB DESCRIPTION

Overview

6 Degrees Health is a healthcare cost containment company dedicated to achieving superior results while prioritizing a best-in-class customer and member experience. We leverage both clinical expertise and innovative technology to deliver fair reimbursements and enhance payment accuracy. With positive change comes growth, so we are currently seeking an Audit Analyst I to join our fun, fast-paced team.

Role Summary

This position is responsible for auditing, verifying and examining suspected insurance for medical, dental and long-term care claim overpayments that we identify on behalf of our insurance carrier clients. To be successful in this position, you must be self-motivated, detail oriented and independent. 

Essential Role Responsibilities

• Verifies insurance data by reviewing spreadsheets, policy documents, and systems to identify overpayments;
• Conducts detailed audits of insurance records and transactions;
• Communicates with team members to train, support, and collaborate in the determination process of verifying information;
• Ensures claims are reviewed and processed in a timely manner;
• Possesses a strong attention to detail and identifies trends within files;
• Provides written feedback with findings and recommendations on completed programs;
• Ensures compliance with industry standards and regulatory requirements;
• Collaborates with other departments to resolve audit findings;
• Maintains current knowledge of insurance regulations and standards;
• Responds to questions related to assigned insurance carrier;
• Achieves daily, weekly, and monthly audit metrics;
• Maintains an average of no more than four Never Overpaid True Audit Errors per month;
• Understands how to review dental, medical and long-term claims and policy documents;
• Audits the following overpayment programs: Claim Voids, True Duplicates, Adjustments, US Senior Care, and Terminated Policies
• Performs other duties as assigned.

Minimum Role Requirements

• Ability to perform the essential job functions
• Professionalism
• Communication Proficiency – written and verbal communication
• Must positively respond to coaching, mentoring and feedback
• Customer/Client Focus
• Problem Solving/Analysis
• Ability to multitask 
• Committed to the mission of the company
• Dedicated to the core values of the company
• Attention to Detail
• Must exhibit high levels of communication, teamwork, professionalism, reliability, respect, etc.)
• Must have a basic level of polices & procedures

Supervisory Responsibility

This position has no supervisory responsibilities

Required Education and Experience

• High school diploma or equivalent.
• Two years of experience with Microsoft Excel is required.
• Possess excellent interpersonal skills, oral and written communication skills.
• Be able to work independently.
• Must be able to focus on the task at hand for an entire day.
• Be detail oriented, accurate, efficient, and precise in completing the tasks associated with the position.

Preferred Education and Experience

• Post high school education or certification is preferred.
• Experience reviewing dental, Medicare/Medicaid billing or auditing is preferred.
• Proficiency with technology, especially computers and software applications. Have intermediate knowledge of Microsoft Excel and Word. Mainframe, “green screen” experience is preferred.
• One year or more of experience with insurance claims examination or processing is highly preferred.

Organizational Benefits

· Medical, Dental, Vision and Other Outstanding Ancillary Benefits

· Training and Development Opportunities

· 9 Paid Holidays

· 401k Program with 3% employer match

· Remote Work Opportunities

Requirements

Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa.

The base salary range for this position is between $16.50 and $19.00 per hour, plus benefits. Please note that the base salary range is a guideline, and that individual compensation will vary based on factors such as overall qualifications, skillsets, competencies, and work location. At 6 Degrees Health, we understand that an outstanding team is the building block of any organization. With a solid foundation, achieving our goals becomes a reality. We are dedicated to creating a safe and inclusive environment for our employees, and those in our communities, and we believe that our community is stronger when everyone is included and appreciated. We are committed to learning, listening, and improving, while celebrating the diversity and humanity of all people. We are committed to providing opportunities for engagement in decision making and ensuring safe transparency to express and challenge ideas. 6 Degrees Health, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

AAP/EEO Statement

6 Degrees Health (DMR) is an affirmative action/equal opportunity employer (AA/EOE). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, sexual orientation, disability status, genetic information, protected veteran status or any other characteristic protected by federal, state or local law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.