Internal Auditor

Mercy-Health-System-Corporation; Janesville (WI); On-site; USD 58,797 - 94,076; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

Generous paid time off

Tuition reimbursement

On-Demand Pay

Employee Discounts

Job summary

Mercy-Health-System-Corporation seeks an Audit Specialist in Janesville, Wisconsin. This role involves comprehensive claims audits, ensuring compliance with fee schedules and processing standards while improving operational effectiveness.

Candidates should have a bachelor’s degree and a minimum of two years of audit experience in the healthcare industry. Mercyhealth provides a competitive salary and benefits including medical insurance, paid time off, and employee discounts.

Qualifications

• Minimum 2 years audit experience in health care industry.
• Preferred certifications: Certified Internal Auditor (CIA), Certified Healthcare Auditor (CHA), Certified Public Accountant (CPA), Registered Health Information Administrator (RHIA).

Responsibilities

• Conduct comprehensive claims audits to ensure compliance and improve operational effectiveness.
• Evaluate claims processing activities and analyze audit results.
• Collaborate with internal stakeholders and create audit reports.

Skills

Effective written and oral communication skills

Excellent analytical/interpretive skills

High degree of accuracy

Proficiency in Excel

Education

Bachelor's degree in accounting or business administration preferred with concentration in health care

Job description

Conduct comprehensive claims audits to ensure compliance with fee schedules, benefit plans, contractual obligations, service-level agreements, and claim turnaround standards. Evaluate claims processing activities for adherence to industry best practices, federal and state regulatory requirements, organizational policies and procedures, provider contracts, and applicable accreditation standards.Analyze audit results, identify trends and areas of risk, and prepare detailed written reports summarizing findings, root causes, and recommendations for corrective action and process improvement. Collaborate with internal stakeholders to monitor compliance, improve operational effectiveness, and support regulatory readiness.MercyCare administers a diverse portfolio of health insurance products, including Medicaid, Exchange, ERISA, and commercial plans, and operates within regulatory frameworks established by the Wisconsin Office of the Commissioner of Insurance (OCI), Illinois Department of Insurance (DOI), and other applicable federal and state agencies. The role requires a strong understanding of health plan operations, claims administration, and regulatory compliance across multiple lines of business.Essential Duties and ResponsibilitiesConduct audit interviews with front line staff in all functional areas that fall under claim operations.Test, create flow charts and map operational processes that touch the outcome of claims accuracy.Perform routine and moderately complex audits on claims for payment integrity in alignment with regulatory standards and timelines, business policy, contract, appropriate coding, and system configuration.Research claim processing issues and errors to determine their origin and appropriate resolution. Interacts with Operations management regarding trends in order to improve claims processing accuracy and incorporate into training programs, policies and procedures.Create audit reports to document audit findings, which will result in audit recommendations, reports and claims audit criteria enhancements.Perform special project audits and reviews as requested by other departments.Education and ExperienceBachelor's degree in accounting or business administration preferred with concentration in health care also preferred.Minimum 2 years audit experience in health care industry.Certification and LicensureThe following certifications are preferred:Certified Internal Auditor (CIA) certificationCertified Healthcare Auditor (CHA)Certified Public Accountant (CPA)Registered Health Information Administrator (RHIA)Skills and AbilitiesEffective written and oral communication skills.Excellent analytical/interpretive skills.High degree of accuracy.Proficiency in application of computers and software programs such as Excel.PAY RANGE:$58,797.66 - $94,076.26Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.Mercyhealth offers competitive pay and a comprehensive benefits package including:Medical, Dental, VisionLife & Disability InsuranceFSA/HSA OptionsGenerous, accruing paid time offPaid Parental and caregiver leaveCareer advancement and educational opportunitiesTuition and certification reimbursementCertification ReimbursementWell-being ProgramsEmployee DiscountsOn-Demand PayFinancial EducationAnnual recognition/awards eventsPartner appreciation daysFamily entertainment/attractions discountCommunity service/improvement opportunitiesClick here for more details regarding Mercyhealth Careers Benefit Information.At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.Mercyhealth has been nationally recognized for our commitment to our people and culture, including:#1 in the nation on AARP's Best Employers for Workers Over 50One of Working Mother magazine's 100 Best Companies for Working MothersA Top 50 Company and Top 10 Nonprofit for Executive Women