Auditor

• Responsible for pre and post payment and adjudication audits of high dollar claims
• Ensures claim payment accuracy by verifying eligibility, pre-authorization, and medical necessity
• Contacts others to obtain necessary information
• Completes and maintains detailed documentation of audits
• Provides feedback on processing errors and identifies quality improvement opportunities
• Handles specialized claims independently (Claims Auditor II)
• Serves as subject matter expert and mentor (Claims Auditor Senior)

Claims Auditor I, II, Senior

Principal DRG Coding Auditor

Staff Auditor

Senior Auditor, IT Audit

External Auditor, Quality Assessment Services

Senior IT Auditor