Manager, Medical Audit Services

· Responsible for internal reference documents for Consultants and Health & Welfare teams, leading training sessions to educate new hire colleagues on medical audit offerings
· Create and maintain audit templates such as audit notification letters, documentation request lists, report templates, sample workbooks, etc.
· Responsible for performing and supporting complex audits of medical plans including but not limited to retrospective claims, operational, pre & post-implementation audits across all lines of business (Commercial, Medicare, Medicaid, Exchange, DSNP, EGWP)
· Lead others in completing audits of medical plans
· Serve as a subject matter expert in claim payment and compliance relative to client contracts, regulatory requirements and vendor health programs
· Utilize results of initial claim data evaluations to select focused audit samples for review and response by the carrier; attend on-site audit to review claims and backup detail as necessary to determine accuracy of claim processing and payment
· Work with carriers to determine root cause of errors, determine impact, and report audit results to clients of varying size and type (employers, health plans, etc)
· Assist Consultants with discovery calls to explore potential clients’ interest in completing audits and developing solutions that meet their unique needs
· Develop a tool to track audit status and results, developing key performance indicators and audit statistics/insights
· Other responsibilities as deemed necessary to support the business
#LI-SM3

· College degree (experience may be considered in lieu of college degree)
· 7+ years’ experience in medical claims auditing or consulting
· Must demonstrate a high level of medical claims and health benefit administration knowledge under various lines of business (Commercial, Medicare, Medicaid)
· Exceptional oral and written communication skills with high attention to detail
· Ability to deliver results per an agreed upon timeline while keeping all stakeholders informed
· Self-directed with strong project management skills
· Ability to adjust to changing priorities without losing momentum toward overarching goals
· Comfortable working collaboratively with others at all levels of an organization
· Strong people leader with the ability to identify others’ motivators and potential for growth
· Intermediate or expert level experience with Microsoft Suite (Word, Excel, PowerPoint)
· Ability to travel as required for audits

Preferred Qualifications & Attributes
· Experience with SQL and/or Alteryx
· Advanced degree in healthcare analytics or similar field
· Experience in medical billing or coding