Auditor, Special Investigations

About the role

The incumbent conducts comprehensive audits of Network Providers (Institutional, Professional, and Allied) for compliance and identifies and remediates Provider fraud, waste, and abuse.

Responsibilities

• Collaborates with Management and the Provider Compliance team to implement proactive Provider billing monitoring.
• Identifies and addresses fraud, waste, and abuse, and implements controls to address identified issues.
• Collaborates with the Clinical Quality and Claims Operations Business Areas to identify and address fraud, waste, and abuse and quality issues.

Requirements

• Bachelor’s Degree in Business or other health-related field required.
• Three (3) years audit experience required, preferably in auditing Institutional providers or related provider auditing.
• Healthcare experience preferred.
• Experience in interpreting data analysis and analytical reporting required.
• PC skills including the Microsoft Office Suite required.
• Effective oral and written communication skills required.

Qualifications

Blue Cross & Blue Shield of Mississippi is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Skills

• Comprehensive auditing skills.
• Data analysis and reporting skills.
• Interpersonal and collaboration skills.
• Strong communication skills.

Benefits

Our benefits program is among the best in the health care field and includes:

• Comprehensive health insurance.
• Paid time off.
• Flexible spending accounts.
• Retirement savings plans.
• Employee assistance programs.

Pay

Details about pay are not specified in this posting.

Schedule

Details about the schedule are not specified in this posting.