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Contract Compliance Auditor- Carve Out

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Job Details
Job Order Number
497383
Company Name
Change Healthcare
Physical Address
Company Worksite
Portland, ME 04103
Job Description

Transforming the future of healthcare isn’t something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.Here at Change Healthcare, we’re using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.If you’re ready to embrace your passion and do what you love with a company that’s committed to supporting your future, then you belong at Change Healthcare.

Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.

Empower Your Future. Make a Difference.

Title: Contract Compliance Auditor – Carve Out

Overview of Position:

The Carve Out Contract Compliance Auditor works independently under the general supervision of a Manager to complete job responsibilities. The Carve Out Contract Compliance Auditor uses established guidelines and healthcare experience as well as independent judgment based on nationally recognized auditing standards, payer contractual guidelines and payment policies to accomplish job responsibilities

What will be my duties and responsibilities in this job?

  • Analyze, review, and validate healthcare claim payments for implantable medical devices
  • Utilize established criteria and guidelines for completing a medical carve out claim audit including nationally recognized auditing standards, contractual criteria and client Implantable Device Reimbursement policy.
  • Communicate audit determinations in writing to the client, provider and appropriate business departments as determined by internal departmental workflow policies
  • Evaluate client reimbursement policy and contractual language as it pertains to claims payment on implantable medical devices.
  • Research government and manufacturer websites for updated implantable device criteria for the Implant Reference Library
  • Review any additional information sent by the provider to substantiate an audit appeal
  • Communicate with the Manager regarding audit appeal rates, auditing issues that arise from appeals, and the need for any change in audit process.

What are the requirements needed for this position?

  • Knowledge of healthcare contracts
  • Demonstrate knowledge of healthcare billing, coding and reimbursement guidelines (Revenue Code, CPT4, HCPCS, and ICD-10)
  • Demonstrate knowledge of implantable medical devices as they relate to surgical procedures
  • Ability to use software, hardware, and peripherals related to job responsibilities
  • Proficient in the use of Word and Excel

What other skills/experience would be helpful to have?

  • Demonstrate ability to prioritize tasks and work well with a team
  • Demonstrate ability to adapt to changing guidelines, criteria, and regulations
  • Demonstrate professional writing skills and strong verbal communication
  • Strong research skills
  • Knowledge of FDA criteria in regards to Implementable Surgical Devices.

What are the working conditions and physical requirements of this job?

General office demands.

How much should I expect to travel?

Occasional travel may be necessary.

Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

  • Education/ Training
  • Associates Degree
  • Minimum of 1 year of healthcare claim review experience preferred
  • Business Experience
  • Demonstrate strong analytical and mathematical skills
  • Demonstrate time management skills and the ability to adhere to strict time frames
  • Demonstrate ability to prioritize tasks
  • Demonstrate ability to work well with a team
  • Demonstrate ability to adapt to changing guidelines, criteria, and regulations
  • Ability to use software, hardware, and peripherals related to job responsibilities
  • Demonstrate professional writing skills and strong verbal communication
  • Extremely detailed oriented
  • Specialized Knowledge/ Skills
  • Demonstrate knowledge of healthcare billing and coding and reimbursement guidelines (Revenue Code, CPT4 codes, HCPCS codes and ICD-10 codes )
  • Demonstrate knowledge of implantable medical devices as they relate to surgical procedures
  • Analyze, review, and validate healthcare claim payments for implantable medical devices
  • Utilize established criteria and guidelines for completing a medical carve out claim audit, nationally recognized auditing standards, contractual criteria and client Implantable Device and Medical Reimbursement policies.
  • Communicate audit determinations in writing to the client, provider and appropriate business departments as determined by internal departmental workflow policies
  • Evaluate client reimbursement policy and contractual language as it pertains to claims payment on implantable medical devices.
  • Research government and manufacturer websites for updated implantable device criteria for the Implant Reference Library
  • Review any additional information sent by the provider to substantiate an audit appeal
  • Write an appeal response to the provider
  • Maintain a commitment to the ethics of professional healthcare auditing
  • Working Conditions:
  • Environment – Office environment, minimal, if any, travel required
  • Physical Requirements – Sitting, standing, walking, and keying information into the auditing system.

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.comwith “Applicant requesting reasonable accommodation” as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdfto view our pay transparency nondiscrimination policy.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an Equal Opportunity Employer. Employment at Change Healthcare is based upon your individual merit and qualifications. We don’t discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, marital status, protected veteran status or disability, genetic characteristic, or any other characteristic protected by applicable federal, state or local law. We will also make all reasonable accommodations to meet our obligations under the Americans with Disabilities Act (ADA) and state disability laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability.


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