Auditor

• Examine claims for compliance with relevant billing and processing guidelines
• Identify opportunities for fraud and abuse prevention and control
• Review and conduct analysis of claims and medical records prior to payment
• Use required systems/tools to accurately document determinations
• Research new healthcare related questions as necessary for investigations
• Stay abreast of current medical coding and billing issues, trends and changes in laws/regulations
• Collaborate with the Special Investigation Unit and other internal areas on matters of mutual concern
• Recommend possible interventions for loss control and risk avoidance based on outcomes

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