SIU Clinical Auditor SelectHealth – Intermountain Healthcare – Murray, UT

Job Description:

Job Essentials

• Reviews large dollar and high risk claims pre-payment utilizing clinical expertise, critical thinking and basic coding skills. Maintains a high level of accuracy auditing to government regulations, SelectHealth contracts, documented processes and procedures, and overall claim accuracy in processing and benefit application.Identifies fraud, waste and abuse in addition to billing errors that have a direct impact to medical expense savings.
• Works in collaboration with internal departments and billing facilities to ensure accurate claims payment, appropriate benefit application and overall regulation compliance.
• Works collaboratively with medical directors, internal and external compliance, and healthcare provider partners to ensure medical policy enforcement, medical necessity and regulatory agencies’ standards.

Minimum Qualifications

• Bachelor’s degree in healthcare related field with active Utah RN license and 5 years broad clinical experience bedside care. Degree must be obtained through an accredited institution. Education is verified.
• 5 years of experience working with insurance claims, medical billing, auditing or healthcare data analysis.
• Certified Professional Coder (CPC) or equivalent professional coding certificate or American Health Information Management Association (AHIMA) related coding certificate and a thorough understanding of coding issues.May obtain within 1 year of hire.
• Demonstrated ability to research, read and interpret medical records.
• Ability to perform critical analysis.
• Intermediate computer skills including basic knowledge of word processing and spreadsheets.

Preferred Qualifications

• Healthcare Anti-fraud Associate designation (HCAFA) and Health Insurance Associate (HIA) from HIAA.
• Excellent organization skills to manage multiples tasks and organize them according to business need and time constraints with minimal supervision.
• Working knowledge of different regulatory standards.
• Familiar with medical billing coding standards.

Physical Requirements:

Corp or SH only

Interact with others requiring the employee to communicate information.
– and –
Operate computers and other office equipment requiring the ability to move fingers and hands.
– and –
See and read computer monitors and documents.
– and –
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

SelectHealth – Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40