Governmental Audit Specialist

The Governmental Audit Specialist position requires a highly motivated and experienced professional to perform daily routines associated with the Compliance Department including data entry, financial analysis, interpretation of Medicare claims and adjustments, creation of and updating spreadsheets, processing of mail, and corresponding with members outside of the department to obtain necessary documentation Initializes access for new users involved in Review Choice Demonstration process.
Assists with data entry and computer related skills.
Communicates and handles incoming and outgoing electronic communications on behalf of Supervisor(s).
Manages multiple projects at a time and follow-through on issues in a timely manner.
Maintains confidentiality appropriate to the departmental activities/functions.
Responsible for mail and fax disbursement within the Government Audit Team.
Composes spreadsheets from electronic databases.
Assists the Supervisor(s) as needed with copying and computer related skills.
Processes the intake of initial medical records requests and prepares for audit.
Investigates CMS database to determine status of claims.
Assists auditors with gathering of documentation and financial claim information.
Identifies denials/nonaffirmations of payment and prepares claims for appeal.
Communicates with CMS representatives on behalf of the department.
Follows up on outstanding review/appeal decisions.
Performs comparable or related duties as may be required of assigned- assists with other areas of Compliance Department as needed.
Record preparation and submission to intermediary for Review Choice Demonstration (MAC).
Assists with Virtual Worker spreadsheet processing and verification of worked performed virtually.
Assist with the processing of claims through Review Choice Demonstration workflow.
Formal Education: High School Diploma or equivalent Experience: 6 months License, Registration, and / or Certification Requirement: No Medical billing|collections experience Data analytics General use of software systems Spreadsheet composition and manipulation Ability to navigate software systems easily Accurate data entry Possession of exceptional interpersonal skills and organizational skills with the ability to meet deadlines Ability to prioritize tasks and use independent judgment skills to make decisions Ability to adapt to frequent change and efficiently work on multiple projects at one time Ability to compose and update Excel spreadsheets and produce reports within set deadlines Ability to effectively communicate with team members and others outside of the department Must be a team player and be willing to assist in other areas of the department as needed