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Behavioral Health Auditor I
Ref No.: 17-00552
Location: Westerville, Ohio
Position Type:Contract
Start Date / End Date: 01/23/2017 to 06/30/2017
The Behavioral Health Auditor I is responsible for behavioral health claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. Main Duties and Responsibilities: - Reviews/validates behavioral health claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. - Performs retrospective chart audits of behavioral health care services. - Collects additional data as necessary to evaluate request. - Applies appropriate clinical criteria. - Prepares letters/findings reports to summarize review activity. - Evaluates, identifies, and reports on, quality of care issues as identified. - Inputs audit results into customized audit tool. Additional Essential Functions: - Ability to communicate both verbally and in writing fluently in English. - Ability to analyze and evaluate medical information. - Ability to work at intermediate level with Microsoft Word and Excel. - Ability to demonstrate excellent customer service skills. - Ability to analyze information and use logic and process to address work- - related issues and problems. - Ability to be careful and thorough about detail. - Ability to function under pressure and deadline oriented project demands as well as manage multiple initiatives. - Average manual dexterity in use of a PC, phone, sorting, filing and other office machines. - Ability to organize well. - Ability to perform oral presentations with good quality. - Ability to perform well in team environment, with staff at all levels, to achieve business goals. - Ability to work independently to meet objectives. - Working knowledge of HIPAA privacy and Security rules. - Ability to travel up to 25%.