Auditor

• Conducts internal and external timely operational, compliance, and financial audits
• Identifies, documents, and evaluates business risks
• Drafts recommendations to limit risks and improve processes
• Writes audit reports for corporate executive management
• Collects and analyzes data to detect deficient controls, fraud, or non-compliance
• Conducts testing of corrective actions
• Develops detailed reports on each audit conducted
• Examines and evaluates financial and information systems
• Conducts special audit studies for management

Medicare Cost Reporting Auditor II

• Conducts internal and external timely operational, compliance, and financial audits
• Identifies, documents, and evaluates business risks
• Drafts recommendations to limit risks and improve processes
• Writes audit reports for corporate executive management
• Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance
• Conducts testing of corrective actions
• Develops detailed reports on each audit conducted
• Examines and evaluates financial and information systems
• Conducts special audit studies for management
• Prepares reports of findings and recommendations for management
• Assists other auditors in completing their assignments

Auditor 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

• Audit and authorize reimbursement of specific medical stop loss claims
• Effectively mitigate client medical stop loss claims and provide excellent customer service
• Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier
• Recognize cost mitigation opportunities
• Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits
• Initiate claims investigations and vendor referrals
• Interpret plan language and identify experimental services and subrogation opportunities
• Identify need for follow-up on pended claims and resolution
• Communicate effectively with carriers, vendors, and management
• Provide full claims service to both phone and written inquiries
• Generate and maintain claims system reports to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history
• Develop new and review old stop loss claim forms
• Assist with internal auditing of claims auditors and training of claims auditors

Senior Auditor, Stoploss Claim

• Independently and objectively helps plan and execute audits in accordance with professional auditing standards
• Performs or supports audits focused primarily on operational controls, asset safeguarding, and compliance with procedures, laws, and regulations
• Functions as in-charge auditor of the most complex audit reviews and/or cost reports
• May conduct reviews of account reconciliations performed by various financial areas
• Identifies and analyzes related key processes, systems, and controls to determine effectiveness
• Communicates audit status and results to management, with emphasis on discussing deficiencies and recommending corrective actions
• Prepares formal written work papers and reports, documenting audit work performed and expressing conclusion
• Assesses desk reviews performed by subordinate auditors to ensure that quality audit work is performed and on-the-job training is provided as necessary
• Assists in ensuring that all assigned audits are completed and reviewed in accordance with Generally Accepted Accounting Principles, Generally Accepted Auditing Standards and, Government Auditing Standards
• Coordinates the completion of these assignments in a manner which results in timely completion of all assignments in accordance with budget performance requirements as well as departmental interim goals
• Directs the day-to-day efforts of assigned audit staff by reviewing and planning assignments, training, and providing leadership and guidance
• Assists in the development and revision of work instructions, forms, and procedures
• Broadens and maintains working knowledge of applicable laws, regulations, and procedures through self-study programs, on-the-job training, attending seminars and network association’s formal training programs
• Communicates with internal and external areas as necessary to ensure efficient completion of assigned tasks

Lead Auditor, Medicare

• Responsible for performing audit and abstraction of medical records (provider and/or vendor)
• Identify and submit ICD codes for risk adjustment processes
• Support coding judgment and decisions using industry standard evidence and tools
• Conduct self-process audits to ensure compliance with internal policies

Auditor jobs in Vermont

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Medicare Cost Reporting Auditor II

Auditor II

Auditor II

Senior Auditor, Stoploss Claim

Lead Auditor, Medicare

Data Quality Auditor