Vespa Group, LLC

The Audit Case Disposition Specialist has multi-functional responsibilities with the Case Disposition team and the Analytics team for the Medicaid Fraud Waste and Abuse Detection Services project.. Monitor the progress of audit cases within the case management system and ensure that appropriate actions are taken. Assist in developing policies, procedures, processes and workflows to support the Audit Case Disposition Process. Provide input into the configuration, testing, implementation and ongoing operations of the case management system. Preferred medical coding experience with one or more of the following credentials: CPC, CPC-C, COC, RHIT, or CPMA.

disposition

Summary: Seeking an Audit Case Disposition Specialist to join our team! The Audit Case Disposition Specialist has multi-functional responsibilities with the Case Disposition team and the Analytics team for the Medicaid Fraud Waste and Abuse Detection Services project.
Must be eligible to work in the US. No sponsorships are available at this time.
Monitor the progress of audit cases within the case management system and ensure that appropriate actions are taken
Assists medical reviewers as required and conducts various Medicaid audits independently
Work collaboratively with members of the client Program Integrity Team to determine the status and final disposition of each case
Review medical records for accuracy, completeness, and consistency with state and federal rules and regulations including professional coding standards
Research Indiana Medicaid rules and regulations and updates repository with new bulletins, policies, and procedures
Prepares the draft and final audit findings reports for medical reviews and audits conducted and submit for Lead approval. Prepare audit letters and other notifications for providers and ensure that the client has approved all letters before they are sent out
Respond to provider inquiries regarding the status of an audit and ensure prompt and provider-friendly approach
Assist with the coordination of the appeals process
Assist with notifications, tracking, collection and reporting of overpayment recoveries
Work with team members to develop appropriate educational materials for providers
Assist in developing policies, procedures, processes and workflows to support the Audit Case Disposition Process
Provide input into the configuration, testing, implementation and ongoing operations of the case management system
Coordinate activities and case dispositions with other functional teams as needed
Recognize situations requiring urgent attention and manages situation through to resolution via escalation and timely communication
Required Skills:
Excellent oral and written communication skills
Strong initiative and ability to work well under pressure with minimal direction
Ability to plan and prioritize work efficiently
Ability to work within well-defined processes
Ability to collaborate within a team-oriented environment
Education and Experience:
Bachelor's Degree required -
3-5 years of experience in customer service, administrative support and/or data entry within the healthcare, insurance, or government sector
Preferred medical coding experience with one or more of the following credentials: CPC, CPC-C, COC, RHIT, or CPMA.
Experience working collaboratively with healthcare providers is strongly preferred
Some knowledge or experience with healthcare claims data and healthcare fraud
Vespa Group is an equal opportunity employer. All qualified applicants will be considered without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, genetic information, status as a protected veteran or status as a qualified Individual with a Disability, or any other characteristic protected by applicable federal, state or local law. For more information, please visitwww.vespa-group.com<br/><br/>#J-18808-Ljbffr

START NEW SEARCH