Payer Audit Analyst

Overview

The Payer Audit Analyst evaluates commercial payer audit requests, analyzes necessary supporting documentation and determines associated risks, opportunities and uncertainties for each audit. The Payer Audit Analyst organizes and tracks the entire audit process, and ensures audit findings are reviewed timely and responses are completed and submitted within the given deadline.

Responsible for identifying and analyzing trends found in audit communications. Evaluates payers' medical policy criteria, determines benchmarks and makes process improvement recommendations. Submits audit responses to payers.

The Payer Audit Analyst is responsible for working with the Senior Payer Audit Analyst to provide training and education materials to team members to drive compliance and to inform leadership of audit developments.

Responsibilities

• Evaluate audit materials related to payer request and determine adherence to medical policies
• Respond timely to all payer audit requests and submit within deadlines
• Analyze progress and results of assigned commercial audit assessments via scorecards, reports or dashboards
• Support and coordinate activities to modify existing standard operating procedures or supplementary training and education to drive further compliance
• Maintain audit structure by providing mid-audit updates on risks, opportunities and uncertainties of findings, as necessary
• Maintain compliance with all appropriate regulatory requirements including HIPAA
• Other duties and requests as assigned

Qualifications

Education & Experience

Required :

Preferred :

Knowledge & Skills

Below is the starting salary range for this position, although offers may differ based on the candidate's location, job-specific knowledge, skills and experience.

61,500 - $86,205

Additional benefits :

exempt - Our total compensation package includes medical, dental and vision benefits, retirement benefits, employee stock purchase plan, paid time off, parental leave, family medical leave, volunteer time off and additional leave programs, life insurance, disability coverage, and other life and work wellness benefits and discounts. Benefits may be subject to generally applicable eligibility, waiting period, contributions, and other requirements and conditions.