Provider Audit Specialist - LPN or RN Ourhrconnect · Columbia, SC Posted yesterday

# Provider Audit Specialist - LPN or RNO

urhrconnect
· Columbia, SCTailor My Resume Start free. No credit card.### About the role Prepares for and performs institutional audits to assess appropriate provider billing and to identify any aberrant billings that may have an impact on reimbursement. Responsible for reviewing all aspects of claim processing to include fraudulent billing practices and to respond to providers on review/audit findings. Responsible for documenting cost savings related to reviews/audits.

Identifies changes with hospital.

Why should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts.

We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Prepares for and performs institutional audits to assess appropriate provider billing and to identify any aberrant billings that may have an impact on reimbursement. Responsible for reviewing all aspects of claim processing to include fraudulent billing practices and to respond to providers on review/audit findings. Responsible for documenting cost savings related to reviews/audits. Identifies changes with hospital.### Work environment

This position is a full-time role, between the hours of 7:30am and 5pm. You will work an 8-hour shift during that time. This is located at 2401 Faraway Drive### Qualifications This position is not eligible for sponsorship now or in the future.### Responsibilities
* Conducts institutional reviews and/or audits to assess appropriate provider billing and to identify any aberrant billings that have an impact on reimbursement. Responsible for timely completion of reviews/audits and responses to inquiries. Ensures appropriateness of what has been billed and should be allowed by reviewing hospital itemized bills and hospital medical record to determine services/charges that are and are not covered and/or allowed to be billed separately.

Researches the claim system to identify other claims related to the one being reviewed/audited. Responsible for timely review of high dollar claims to minimize the time between receipt of the claim and completion of the high dollar review so the claim can be paid. Some day and overnight travel to hospital locations throughout the state of South Carolina may be needed in order to perform and complete onsite audits.
* Analyzes audit findings and completes letters and reports providing the discrepancies between the medical records and the itemized bill to the provider. Responsible for notifying and providing the claim operation departments with high dollar review findings so the claim can be processed for payment. Completes and maintains audit files and internal tracking tools for each audit. Responsible for ensuring that over payments to the provider have been recovered through claim reviews/processing and use of internal refund tracking systems.

Responds to provider inquiries related to audit findings.

Posted Yesterday Job  Type Full-time Location
* Columbia, SC