Hospital Auditor

The Hospital Auditor will conduct inpatient claim reviews by reviewing detail claim statements, medical records and other data to validate inpatient claim charges and ensure claims are paid at appropriate rates.  This position interfaces with clinical and administrative auditors, as well as Medica medical directors and other internal and external customers of all levels within a hospital facility. This individual is a key stakeholder in complex claims issue resolution. Will make recommendations to Medica to generate cost savings and facilitate accurate reimbursement to providers. Will also work directly with facility CFOs, Administrators, etc. that do not otherwise have participation agreements with Medica and would otherwise be paid 100% of billed charges.  Also responsible for negotiating individual reimbursement agreements with non-participating facilities to secure discounted reimbursement.Bachelor's degree or equivalent healthcare experience.  RN preferred, but not required.  2+ years of the following experience required: managed care, hospital claim auditing, and facility coding.  Familiarity with industry standard hospital reimbursement methods such as DRG, per diem, per case reimbursements.  Demonstrated experience analyzing data and processes and developing recommendations.