Job Description

Devlin Consulting Inc. is the payment accuracy expert! We work with healthcare organizations to recover money, improve processes, strengthen relationships and maximize their value. As we continue to grow, we are seeking an experienced Senior Audit Operations Analyst to join our team. This is a great opportunity to join a well-established company with competitive pay, work remotely, opportunities to develop professionally and excellent benefits.

This is a senior position with responsibility for identifying new audit opportunities, researching new pricing methodologies, engaging with various work teams to generate systems automation and enhancement capabilities in Devlin’s state of the art audit workstation. As a successful Senior Audit Operations Analyst, you will identify, develop, and implement new concepts that will recognize incorrect payments. Concepts are developed based on your industry experience, regulatory research, and your ability to analyze medical claim data to discover incorrect payments. You will be responsible for analyzing client data and generating high quality recoverable claims for the benefit of Devlin Consulting Inc. and our clients. You will assist in the identification, validation and documentation of moderate to more complex recovery projects. You will also be responsible for executing more independent projects assigned by your Operations Manager. If you are successful at thinking “outside of the box”, very analytical and love problem/puzzle solving complex medical claims, then look no further, review the position and requirements below and apply now!

Responsibilities:

• Utilizing healthcare experience to perform audit recovery procedures
• Identify overpaid claims
• Identifying and defining issues, developing criteria, reviewing, and analyzing contracts and Health Plan reimbursement policies and the various state and federal regulations
• Entering and documenting the incorrect payment issue into Devlin’s systems accurately and in accordance with standard procedures
• Updating and developing new and current audit recovery report ideas and then working with the IT team to automate the process
• Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings

Success Factors:

• Bachelor’s Degree preferred
• 4+ year’s knowledge of direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician Claims required
• Certified Professional / Hospital Coder Certification (CCS, CPC, CPC-H, CCS-P, CCRC, CCS-A, RHIA, RHIT ) preferred
• Prior claims auditing or consulting experience desirable in either a provider or payer environment
• Excellent communication skills both oral and written
• Strong interpersonal skills that will support collaborative team work
• Microsoft Office Proficient: Word and Excel; Access – highly preferred

Company Description

Devlin Consulting Inc. works with healthcare organizations to audit claims payments to determine payment accuracy, improve processes, strengthen relationships and maximize value to the client. We are a fast growing and highly successful payment accuracy firm with a long history of success. As we continue to grow, we are seeking experienced Medical Claims Auditors to join our team. This is a great opportunity to join a well-established company, working from home, with excellent pay, competitive benefits, flexible work hours and many opportunities to develop professionally.