Audit Verifier 1

Job Description

Summary/Objective

This position is responsible for auditing, verifying and examining suspected insurance for medical, dental and long-term care claim overpayments that we identify on behalf of our insurance carrier clients. To be successful in this position, you must be self-motivated, detail oriented and independent.

Essential Functions

• Verifies insurance data by reviewing spreadsheets, policy documents, and systems to identify overpayments;
• Conducts detailed audits of insurance records and transactions;
• Communicate with team members to train, support, and collaborate in the determination process of verifying information;
• Ensures claims are reviewed and processed in a timely manner;
• Possesses a strong attention to detail and identifies trends within files;
• Provides written feedback with findings and recommendations on completed programs;
• Ensures compliance with industry standards and regulatory requirements;
• Collaborates with other departments to resolve audit findings;
• Maintains current knowledge of insurance regulations and standards;
• Responds to questions related to assigned insurance carrier;
• Strives to uphold the core values of 6 Degrees Health - DMR, Be Polite, Be Persistent, and Be Proactive
• Achieves daily, weekly, and monthly audit metrics;
• Maintains an average of no more than four Never Overpaid True Audit Errors per month;
• Understands how to review dental, medical and long-term claims and policy documents;
• Audits the following overpayment programs: Claim Voids, True Duplicates, Adjustments, US Senior Care, and Terminated Policies; and
• Performs other duties as assigned.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

Competencies

• Ability to perform the essential job functions
• Professionalism
• Communication Proficiency – written and verbal communication
• Must positively respond to coaching, mentoring and feedback
• Customer/Client Focus
• Problem Solving/Analysis
• Ability to multitask
• Committed to the mission of the company
• Dedicated to the core values of the company
• Attention to Detail
• Must exhibit high levels of communication, teamwork, professionalism, reliability, respect, etc.)
• Must have a basic level of polices & procedures

Supervisory Responsibility

This position has no supervisory responsibilities

Required Education and Experience

• High school diploma or equivalent.
• Two years of experience with Microsoft Excel is required.
• Possess excellent interpersonal skills, oral and written communication skills.
• Be able to work independently.
• Must be able to focus on the task at hand for an entire day.
• Be detail oriented, accurate, efficient, and precise in completing the tasks associated with the position.

Preferred Education and Experience

• Post high school education or certification is preferred.
• Experience reviewing dental, Medicare/Medicaid billing or auditing is preferred.
• Proficiency with technology, especially computers and software applications. Have intermediate knowledge of Microsoft Excel and Word. Mainframe, “green screen” experience is preferred.
• One year or more of experience with insurance claims examination or processing is highly preferred.

Eligibility Qualifications

• Passing of skill test will be required.
• Intermediate Windows & MS Office Skills are mandatory.
• Must attend all days of onboarding training. If unable to attend all days of the training which are held in the first 30 days, the applicant will be rescheduled for the next available training. If unable to attend all days of the rescheduled training, the employee will be released from employment.

Internal Candidate Eligibility Qualifications

• Must be regular employee who has completed their introductory period.
• Cannot have any written warnings or performance improvement plans currently in place.
• Problem-solving initiative in an 6 Degrees Health-DMR role as documented by their department director and/or performance evaluations.

Work Authorization

Candidates selected will be subject to a pre-employment background investigation (drug test, credit check, reference verification) and skills test.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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