Payer Audit Analyst

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.

• 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

Education & Experience

Required:

• Bachelor's degree or equivalent combination of education and experience
• 2-4 years' experience in medical device industry, compliance, reimbursement, health insurance or related field

Preferred:

• Medical Device Background
• Previous Audit or Compliance Experience
• Process Improvement Experience
• Knowledge and understanding of medical terminology

Knowledge & Skills

• Analytical
• Self-starter with the ability to work independently
• Eagerness to learn
• Strong computer and presentation skills
• Strong proficiency with Microsoft Excel and PowerPoint
• Strong sense of urgency, adaptability, flexibility and resourcefulness
• High attention to detail, follow-up and organizational skills
• Strong communication skills
• Good critical thinking skills
• Able to communicate comfortably and effectively both verbally and in writing with all levels of professionals