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Durable Medical Equipment and Home Health Auditor

Company: Conduent
Location: Cherry Hill
Posted on: June 11, 2018

Job Description:

Durable Medical Equipment and Home Health Auditor Requisition ID: Primary Location:United States-New Jersey-Cherry HillCategory:Service Delivery Healthcare DescriptionConduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at .The Durable Medical Equipment and Home Health Care Auditor is responsible for conducting Durable medical Equipment, Home Health care and other specialty audits. Primary Job Responsibilities: Field AuditsPerform field audits at Durable Medical Equipment and Home Health Care providers and at other specialty provider sites by traveling to provider-sites and examining source documents such as orders and patient medical records.Validate and document all audit findings.Conduct audits in accordance with audit guidelines.Be able to identify fraud and abuse, and document it.Interview providers and witnesses regarding potential fraud schemes,and document such interviews.Back up all findings with applicable citations in federal, state and plan rules & regulations.Audit support activitiesPrepare for audits, making sure that the appropriate data samples are drawn, work papers are ready and providers are notified.Conduct In-house audit tasks.Conduct Desk-Audits of provider data to target questionable billing practices.Perform post-audit activities such as discrepancy validation and other follow-up.Generate final reports for the client.Audit Follow-UpEdit, validate and report audit findings.Provide back-documentation during negotiation proceedings.Participate in administrative hearings and court proceedings when necessary.Other analysesConduct other audit and data analyses as required.Review data and claim information to support account management. Education / Licensure: At minimum must be a Certified Professional Coder If an HCS designation is not currently held, must be willing to obtain it within 6 months of employment Current certificate must be in good standing Experience:A minimum of two to five years experience in Durable Medical Equipment/Home Health Care coding.Durable Medical Equipment/ Home Health Care auditing experience a plus.Experience in managed care or experience with health claims processing is preferred.No record of felony convictions, any record of Medicaid, Medicare or Private Payer sanctions for fraud, abuse or inappropriate billing. Skills: Thoroughness: Complete tasks 100% and pay attention to detail. Be willing to go the extra mile to follow through on audits, run down leads, dig for fraud and abuse. Properly and consistently adhere to standard auditing and investigative guidelines, document all findings and communications, and create a complete audit trail. Respond to all client requests. Let nothing slip through the cracks. Communication: With good grammar and form, cohesively & concisely communicate written audit reports and work product documentation. Be able to verbally communicate in a professional & pleasant manner in potentially combative audit situations. Confidence / Self Assuredness: Must be able to handle irritated or irate audit subjects and diffuse tense situations. Must be able to operate in a sometimes-tense environment and still reach objective of completing the audit. Results Orientation: Take the initiative to tweak & redirect efforts in order to make the account successful. Chase down the leads that will yield the greatest degree of fraud and recoveries. Flexibility: Must adapt and be able to handle a changing schedule and ranging responsibilities. Problem-Solver: Must be able to think through complex situations and fraud schemes,and identify the pattern of abuse. Must be able to work independently and get the job done with minimal supervision. Full-time position requiring up to 50% nationwide travel. Audit travel may require up to 4 days per week of travel depending upon location. For example- departure for audit locations on Sunday evening and return to home location on Thursday.Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation() by clicking on the following link, completing the accommodation request form, and submitting the request by using the \"Submit\" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form .Travel:Yes, 50 % of the TimeJob Type:ExperiencedOrganization:Financial Service + Healthcare

Keywords: Conduent, Cherry Hill, Durable Medical Equipment and Home Health Auditor, Healthcare, Cherry Hill, New Jersey

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