Fiscal Compliance Auditor

Description:
Serves as a liaison to MHA, the Office of the Comptroller, DHMH Office of the Attorney General, Office of Medicaid Fraud and the DHMH Office of the Inspector General regarding fiscal and claims compliance issues. Coordinate with the claims subcontractor related to development of claims policy and recovery of incorrectly paid claims. Assist with oversight of claims contractor activities. Develops and implements policies and procedures to support compliance with regulations Represents the ASO with the various regulatory agencies identified above regarding claims compliance issues identified through provider on-site audits, through fraud and abuse edits in the claims processing system and through other means Develops, reviews and reports upon claims subject to post-payment audit review, including development of profiles of billing practices Develops and maintains audit program for internal quality control of claims payments, including auditing of samples of claims Coordinate with MHA and claims subcontractor to define claims policy related to claims payments and collection of federal funds participation (FFP) Assist with claims resolution of problem claims requiring detailed interface between APS and the claims subcontractor, including Policy Exception Memos (PEM) Monitor and track the change order process
Visit our website at:www.apshealthcare.comReferral bonus available to APS Healthcare Employees*
In accordance to guidelinesAPS HEALTHCARE Bethesda, Inc. and its subsidiaries and affiliates (APS) are Equal Opportunity Employers which employ qualified individuals based upon job related qualifications regardless of race, religion, color, sex, national origin, age, disability, or any other classification proscribed under applicable federal, state, or local law. APS complies with the law regarding reasonable accommodation for disabled employees. Applicants requiring reasonable accommodation in order to participate in the interview process are requested to contact Human Resources in order to arrange such accommodation.
REQUIREMENTS
Requirements:
A minimum of 3 years prior experience in claims, finance and/or auditing Understanding of contracting/billing language and guidelines Strong analytical skills with attention to detail Previous experience in behavioral health care preferred
Education:
Bachelor's degree in finance or equivalent work experience in related field.