Auditor II – Data Mining
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Job Description
Data Mining Auditor reviewing healthcare claims to identify and validate overpayments. Documenting findings for EXL’s healthcare auditing and payment integrity operations.
Responsibilities:
- Review output of queries for overpayments
- Follow Query Step-by-Step Documentation to validate overpayments
- Utilize claims system(s), if available, to verify overpayments
- Document overpayments/non-overpayments in production systems, articulating clear reasons for claims not overpaid
- Meet quality and production standards
- Record production tasks and time in the format outlined by Management
- Communicate issues that may impede completion of assigned work to Management
- Work with Management to resolve issues
- Provide feedback to Management on areas of improvement
Requirements:
- High School Diploma or Equivalent Required
- College Degree or Equivalent Work Experience
- Maintain OIG/GSA clearances
- Attention to Detail
- Excellent written and oral communication skills
- Flexible during times of change; able to adjust to shifting priorities and timelines through analytical and problem solving capabilities
- Must be able to learn, understand, and apply new technologies
- Knowledge of CMS guidelines
- Strong knowledge of HCPC, CPT and other coding methodologies
- Spreadsheet, word processing, and database knowledge
- Preferred: 1-2 Years’ Experience Auditor
- Preferred: 1-2 Years’ Experience with Medical Claims Processing
Benefits:
- Benefits information provided at https://www.exlservice.com/us-careers-and-benefits
- Work from home
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