Health Plan Auditor

Healthcare Data Management seeks a health plan auditor with a strong background and experience in health plan administration, financial auditing, claims auditing, claims processing and payment systems, self-funded companies and third party administrators. This person is responsible for conducting audits of third party administrators on the behalf of clients that are self-insured employer groups.

 

For more information about HDM visit http://www.hdminc.com

 



Requires experience and the ability to perform:

 ASO Agreement AuditsOperations/Internal Control AuditsFinancial Funding AuditsSample Claim AuditsDiscount Audits

REQUIREMENTS:

 



Experience: To qualify, you must have at least 10 years experience in health benefits auditing or health plan administration or managing claims processing, as well as strong accounting and financial experience.

 

Written Communications: Ability to write comprehensive audit reports, document findings, and communicate analysis in a clear style. It requires the ability to be detail oriented and focused on delivering a quality service.

 

Oral Communications: The person must be professional when contacting clients and administrators, have the ability to conduct entrance and exit interviews with administrators and have the ability to interface with corporate executives.

 

Technical: Requires computer experience and the ability to use Microsoft Word and Excel. Ability to communicate by e-mail and ability to use the internet.

 

Personality: Requires a strong personality with high-energy level and self-confidence, a self-starter, who thrives on contact with people and who enjoys operating in an entrepreneurial environment. Requires problem solving and analytical capabilities, and a desire to offer outstanding customer service.

 

Travel: Position requires periodic travel to plan administrators for approximately one week per audit.

 

PRINCIPLE ACTIVITIES:

 

Meeting Objectives of Audits: HDM auditors measure administrator performance, evaluate contract compliance, evaluate discounts, audit claims and recover overpayments. The audit provides our clients with assurance of their fiduciary responsibilities, compliance with Sarbanes-Oxley, government auditing standards and measure performance of vendors.

 

Onsite Operations Audit: HDM auditors initiate a comprehensive onsite review at the third party administrator. The purpose is to evaluate the control environment. During the onsite visit, we assess mail operations, claim processing and check processing. We review internal control policies and procedures and determine if errors or irregularities have occurred or the likelihood of them occurring

 

Onsite Claims Audit: Conduct a claim sample audit at third party administrators. 

 

Discount Audit: The auditor determines the discount arrangement and tests it as the result of the claim audit. 

 

Contract Compliance Audit: The auditor performs a compliance audit of the contract the client has with the administrator, including testing performance guarantees.

 

Reporting: The auditor is responsible for documenting the onsite audit and developing Draft and Final Audit Reports

 

Communications: The auditor participates in conference calls and meetings with clients and administrators.

 



Compensation:

 

HDM seeks full time employees in our King of Prussia, PA office. Compensation includes salary, health insurance, 401K and other benefits. HDM offers an opportunity to grow with an exciting company.