Manager, Medical Audit Services
Lockton Companies, Minneapolis, MN, United States
Minneapolis, Minnesota, United States of America
Responsible for internal reference documents for Consultants and Health & Welfare teams, leading training sessions to educate new hire colleagues on medical audit offerings
Create and maintain audit templates such as audit notification letters, documentation request lists, report templates, sample workbooks, etc.
Responsible for performing and supporting complex audits of medical plans including but not limited to retrospective claims, operational, pre & post-implementation audits across all lines of business (Commercial, Medicare, Medicaid, Exchange, DSNP, EGWP)
Lead others in completing audits of medical plans
Serve as a subject matter expert in claim payment and compliance relative to client contracts, regulatory requirements and vendor health programs
Utilize results of initial claim data evaluations to select focused audit samples for review and response by the carrier; attend on-site audit to review claims and backup detail as necessary to determine accuracy of claim processing and payment
Work with carriers to determine root cause of errors, determine impact, and report audit results to clients of varying size and type (employers, health plans, etc)
Assist Consultants with discovery calls to explore potential clients’ interest in completing audits and developing solutions that meet their unique needs
Develop a tool to track audit status and results, developing key performance indicators and audit statistics/insights
Other responsibilities as deemed necessary to support the business
Qualifications
College degree (experience may be considered in lieu of college degree)
7+ years’ experience in medical claims auditing or consulting
Must demonstrate a high level of medical claims and health benefit administration knowledge under various lines of business (Commercial, Medicare, Medicaid)
Exceptional oral and written communication skills with high attention to detail
Ability to deliver results per an agreed upon timeline while keeping all stakeholders informed
Self-directed with strong project management skills
Ability to adjust to changing priorities without losing momentum toward overarching goals
Comfortable working collaboratively with others at all levels of an organization
Strong people leader with the ability to identify others’ motivators and potential for growth
Intermediate or expert level experience with Microsoft Suite (Word, Excel, PowerPoint)
Ability to travel as required for audits
Preferred Qualifications & Attributes
Experience with SQL and/or Alteryx
Advanced degree in healthcare analytics or similar field
Experience in medical billing or coding
Equal Opportunity Statement
Lockton Companies is proud to provide everyone anequal opportunity to grow and advance. We are committed to an inclusive culture and environment where our people, clients and communities are treated with respect and dignity.
At Lockton, supporting diversity, equity and inclusion is ingrained in our values, and we believe that we are at our best when we fully embrace everyone. We strive to cultivate a caring culture that learnsfrom, celebrates and thrives because of ourbreadth of differences. As such, we recognize that recruiting, developing and retaining people with diverse backgrounds and experiences is vital and enabling our people to thrive personally and professionally is critical to our long-term success.
How We Will Support You
At Lockton, we empower you to be true to yourself in all that you do. Your success is our success, and we provide opportunities to help you grow and create a rewarding career path, however you envision it.
We are ready to meet you where you are today, and as your needs change over time. In addition to industry-leading health insurance, we offer additional options to support your overall health and wellbeing.
Any Employment Agency, person or entity that submits an unsolicited resume to this site does so with the understanding that the applicant's resume will become the property of Lockton Companies, Inc. Lockton Companies will have the right to hire that applicant at its discretion and without any fee owed to the submitting Employment Agency, person or entity. Employment Agencies, who have fee Agreements with Lockton Companies must submit applicants to the designated Lockton Companies Employment Coordinator to be eligible for placement fees.
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Responsible for internal reference documents for Consultants and Health & Welfare teams, leading training sessions to educate new hire colleagues on medical audit offerings
Create and maintain audit templates such as audit notification letters, documentation request lists, report templates, sample workbooks, etc.
Responsible for performing and supporting complex audits of medical plans including but not limited to retrospective claims, operational, pre & post-implementation audits across all lines of business (Commercial, Medicare, Medicaid, Exchange, DSNP, EGWP)
Lead others in completing audits of medical plans
Serve as a subject matter expert in claim payment and compliance relative to client contracts, regulatory requirements and vendor health programs
Utilize results of initial claim data evaluations to select focused audit samples for review and response by the carrier; attend on-site audit to review claims and backup detail as necessary to determine accuracy of claim processing and payment
Work with carriers to determine root cause of errors, determine impact, and report audit results to clients of varying size and type (employers, health plans, etc)
Assist Consultants with discovery calls to explore potential clients’ interest in completing audits and developing solutions that meet their unique needs
Develop a tool to track audit status and results, developing key performance indicators and audit statistics/insights
Other responsibilities as deemed necessary to support the business
Qualifications
College degree (experience may be considered in lieu of college degree)
7+ years’ experience in medical claims auditing or consulting
Must demonstrate a high level of medical claims and health benefit administration knowledge under various lines of business (Commercial, Medicare, Medicaid)
Exceptional oral and written communication skills with high attention to detail
Ability to deliver results per an agreed upon timeline while keeping all stakeholders informed
Self-directed with strong project management skills
Ability to adjust to changing priorities without losing momentum toward overarching goals
Comfortable working collaboratively with others at all levels of an organization
Strong people leader with the ability to identify others’ motivators and potential for growth
Intermediate or expert level experience with Microsoft Suite (Word, Excel, PowerPoint)
Ability to travel as required for audits
Preferred Qualifications & Attributes
Experience with SQL and/or Alteryx
Advanced degree in healthcare analytics or similar field
Experience in medical billing or coding
Equal Opportunity Statement
Lockton Companies is proud to provide everyone anequal opportunity to grow and advance. We are committed to an inclusive culture and environment where our people, clients and communities are treated with respect and dignity.
At Lockton, supporting diversity, equity and inclusion is ingrained in our values, and we believe that we are at our best when we fully embrace everyone. We strive to cultivate a caring culture that learnsfrom, celebrates and thrives because of ourbreadth of differences. As such, we recognize that recruiting, developing and retaining people with diverse backgrounds and experiences is vital and enabling our people to thrive personally and professionally is critical to our long-term success.
How We Will Support You
At Lockton, we empower you to be true to yourself in all that you do. Your success is our success, and we provide opportunities to help you grow and create a rewarding career path, however you envision it.
We are ready to meet you where you are today, and as your needs change over time. In addition to industry-leading health insurance, we offer additional options to support your overall health and wellbeing.
Any Employment Agency, person or entity that submits an unsolicited resume to this site does so with the understanding that the applicant's resume will become the property of Lockton Companies, Inc. Lockton Companies will have the right to hire that applicant at its discretion and without any fee owed to the submitting Employment Agency, person or entity. Employment Agencies, who have fee Agreements with Lockton Companies must submit applicants to the designated Lockton Companies Employment Coordinator to be eligible for placement fees.
#J-18808-Ljbffr