Auditor II - Data Mining
About the Role
EXL is seeking a Data Mining Auditor to join our Payment Integrity team!
Key Skills for This Role
Full Job Posting
Qualifications
- Attention to Detail
- Excellent written and oral communication skills
- Flexible during times of change - Adjust to shifting priorities and timelines through analytical and problem solving capabilities
- Must be able to learn, understand, and apply new technologies
- Knowledge CMS guidelines
- Strong knowledge of HCPC, CPT and other coding methodologies
- Spreadsheet, word processing, and database knowledge
- Educational Qualifications:
- High School Diploma or Equivalent Required
- College Degree or Equivalent Work Experience
- Maintain OIG/GSA clearances
- Preferred Experience:
- 1-2 Years’ Experience Auditor
- 1-2 Years’ Experience with Medical Claims Processing
- The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.
Responsibilities
- Reviews output of queries for overpayments.
- Follow Query Step-by-Step Documentation to validate overpayments.
- If available, utilize claims system(s) to verify overpayments.
- Document overpayments/non overpayments in production systems. Claims not overpaid should have clear reasons articulated for research purposes and quality assurance.
- Meet quality and production standards.
- Record production tasks and time into format outlined by Management.
- Communicate to Management any issue(s) that would impede completion of assigned work.
- Work with Management to ensure these issues are resolved.
- Provide feedback to Management on areas of improvement.
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