Configuration - Configuration Monitoring Specialist 200-1012

Job Summary

Responsible for performing planned financial, network and operational audits and/or special reviews. The audits will provide verification of compliance with established controls, policies, plans and procedures as well as adequacy and effectiveness of the system set up.

Key Requirements

• Audit all networks.
• Audit all operational departments.
• Track and trend all errors found during the audit process and supply feedback to management.
• Establish training needs for operational departments identified during the audit process.
• Distribute monthly audit reports to management.

Qualifications

• Ability to perform detailed mathematical calculations and understanding of mathematical concepts and abstract reasoning.
• Ability to manage multiple tasks simultaneously.
• Successful completion of Health Care Sanctions background check.
• Possess strong oral and written communication skills.
• Working knowledge of claims processing systems.
• Ability to converse and write fluently in English.
• Knowledge of claims processing manuals and health benefit designs/booklets.
• Ability to interact with personnel at all levels.
• Ability to read and have a clear understanding of claims processing manuals, medical terminology, ICD9, CPT4 coding, perform claims processing procedures and interpret contractual agreements.
• Highly organized and attentive to detail.
• Proficient in Microsoft applications.

Education/Experience

• High School diploma or equivalent; associate degree preferred.
• 2 to 4 years of experience working with claims insurance, quality review, auditing or training required.