Senior Claims Audit Analyst

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 85,000 - 110,000; Full time

Job summary

Independence Blue Cross is seeking a Sr. Audit Analyst to lead external audit timelines and improve audit practices across the organization.

The role focuses on healthcare claims audits and coordination with multiple departments to ensure accurate, timely responses and documentation. The incumbent will review and modify internal responses for external audiences, maintain audit documentation, and monitor systemic issues while serving as a primary information resource for audit requirements and

Qualifications

• BA/BS in Business Administration, Accounting, or related discipline, or equivalent knowledge by experience.
• Five (5) or more years of healthcare claims audit or related experience.
• Extensive knowledge of audit procedures and practices for external audits.
• Familiarity with MTM, LDLA, and MSP guidelines.
• Knowledge of ITS and OSCAR for eligibility, enrollment and claim processing.
• Working knowledge of benefits coding and HMO/PPO product types.
• Knowledge of pharmacy services.

Responsibilities

• Ensure the meeting of the timeline for external audits.
• Address the most problematic functions with external audits to ensure timely, complete execution.
• Review internal responses from departments for accuracy and completeness.
• Modify responses for appropriate audience (internal/external).
• Prepare audit supporting documentation.
• Perform and develop operational audits and provide results.
• Monitor the resolution of systemic issues.
• Serve as information resource to Audit and client management regarding audit requirements and processes.

Skills

Audit procedures

Healthcare audits

MTM/LDLA/MSP guidelines

Interplan Teleprocessing System ITS

OSCAR eligibility system

Benefits coding knowledge

Pharmacy services knowledge

Customer service trust

Education

BA/BS in Business Administration or Accounting

Tools

ITS (Interplan Teleprocessing System)

OSCAR system

Job description

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

Sr. Audit Analyst Responsibilities

• Ensure the meeting of the timeline for external audits.
• Address the most problematic and difficult functions associated with the External Audit function to ensure timely and complete execution of external audits in accordance with sound audit practices and regulations.
• Review all internal responses from departments for accuracy and completeness.
• Modify responses to address properly the audience for an internal or external party.
• Prepare audit supporting documentation.
• Perform and develop operational audits and provide results.
• Monitor the resolution of systemic issues.
• Serve as information resource to Audit and client management regarding audit requirements and processes.

Qualifications/Skills

• BA/BS in Business Administration, Accounting, or related discipline, or equivalent knowledge acquired by on-the-job training and experience.
• Five (5) or more years of healthcare claims audit or progressively more responsible experience in Customer Service, Enrollment, Claims, Provider Services, Medicare, Quality, or related administrative activities
• Extensive Knowledge of audit procedures, requirements, and practices related to these audits.
• Have familiarity and Acquire Working Knowledge Working with BCBSA guidelines for Member Touchpoint Measures (MTM), BCBSA Line Desk Level Audit (LDLA), and Multi-State Plan (MSP).
• Extensive Knowledge of all key operating systems such as Interplan Teleprocessing System (ITS) and OSCAR for eligibility, customer service, enrollment, and claim processing issues.
• Working Knowledge of benefits coding, and package types for the HMO and PPO products.
• Working Knowledge of pharmacy services.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.