Palmetto GBA

Auditor

• Conducts internal and/or external audits
• Identifies, documents, and evaluates business risks
• Develops written audit programs
• Conducts testing and analysis of existing controls
• Prepares written work papers to document testing results
• Serves as Lead Auditor on complex audit assignments
• Writes audit reports for corporate management
• Collects and analyzes data to detect deficiencies
• Provides training to other auditors

Auditor III

Claims Specialist

• Reviews and adjudicates complex or specialty claims
• Determines whether to return, deny or pay claims following organizational policies and procedures
• Assists in training or mentoring new staff members
• Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes
• Verifies that claims have been keyed correctly
• Ensures that claims are processing according to established quality and production standards
• Corrects processing errors by reprocessing, adjusting, and/or recouping claims
• Researches and resolves claims edits and deferrals
• Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas
• Responds to routine correspondence and completes spreadsheet if applicable

Claims Processor II

• Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation including evaluation of internal controls
• Identifies, documents, and evaluates business risks
• Documents issues, the causes of those issues, and their effects on the process/function and the corporation
• Drafts recommendations to limit risks and improve processes, functions and activities
• Writes audit reports for corporate executive management that clearly and effectively convey engagement evaluations, conclusions, and recommendations
• Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws, regulations, and management policies
• Conducts testing of corrective actions as identified
• Develops detailed reports on each audit conducted
• Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes
• Examines and evaluates financial and information systems, recommending controls to ensure system reliability and data integrity
• Conducts special audit studies for management, such as those required to discover controls for prevention of fraud
• Prepares reports of findings and recommendations for management
• Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel

Auditor III

Claims Processor II

Medicare Cost Reporting Auditor II