Payment Integrity Auditor/Claims Processor

 Devoted Health - Company site
 November 24, 2021
A bit about us: 
We’re on a mission to change healthcare — how it’s paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. 
That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company — one that combines compassion, health insurance, clinical care, and technology seamlessly. 
“We want to partner with people we love for a cause we believe in. Life is short. Join us.
Why Devoted: 
Make a difference… a big difference. You will have the opportunity, in a unique and dynamic culture, to be a part of something incredibly meaningful. We’re a disruptive startup with an inspiring mission. Learn and grow alongside our world-class team of healthcare, technology, and data leaders, dedicated to building a health plan and clinical services that care for everyone like they were our own mothers or fathers. Our team and board members have decades of experience in health care entrepreneurship, data, technology, services, and policy. With their support, we look forward to building a health plan and clinical services that will give seniors easy access to the high-quality care they deserve.
A bit more about this role: 
At Devoted, we know that one of the most important ways we will build trust is by ensuring we can pay claims accurately and on time, while providing the strategic flexibility to change payment models. Our Payment Integrity Operations team is responsible for managing Claim audit and adjustment functions and driving projects to prevent repetitive errors.  Devoted is committed to building a team of people, effective processes and proprietary technology that delivers industry leading claims payment, accuracy and provider satisfaction. Devoted Health is building the core technology platform from the ground up. The Payment Integrity Auditor is responsible for identification and validation of over-payments, performing root cause analysis, and  proposing improvement projects to prevent repetitive errors. This position will ensure overall quality of claim payment.

Responsibilities include:

  • Conducts claim audit reviews across multiple claim types and workflows including Dual eligible members to determine if claims are appropriately paid in accordance with benefits, contracts and edits, includes review of specific coding and billing guidelines
  • Documents findings within audit tracking system in a thorough and objective manner and with high accuracy
  • Validate over-payments identified by vendor partners and assists with Vendor performance reporting
  • Reprocess claims according to Devoted guidelines and established payment policy.
  • Coordinates with clinical team for clinical validations audits
  • Work to identify, document, and propose solutions for areas of improvement
  • Perform other duties as assigned to support payment integrity functions
  • Attributes to success:

  • Curiosity and willingness to ask questions
  • A deep desire to improve and make a change in the healthcare experience
  • Preference towards collaboration and preventing silos
  • You will roll up your sleeves and do whatever it takes to get the job done
  • Ability to work in a fast-paced start-up environment
  • Desired skills and experience:

  • 2-3 years experience in an auditor role with responsibilities across multiple Payment Integrity disciplines including Subrogation, COB, FWA/ SIU, Data Mining, DRG, HBA, Credit balance etc
  • 2-3 years experience processing claims across multiple claim types
  • Good knowledge of Medicare policies and claim and insurance terminology. 
  • Experience contributing to improvement of audit query concepts
  • Excellent ability to build and maintain positive relationships with business and 3rd party partners 
  • Experience with performing root cause analysis of claim payment errors 
  • Strong written, verbal, and interpersonal communication skills required
  • 1-2 years experience contributing to development of Standard Operating Procedures a plus
  • CPC (Certified professional coder) also a plus
  • #LI-SS1
    If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!  If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.
    Devoted is an equal opportunity employer.  We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
    As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
    COVID-19 Vaccination Requirement: Where permitted by applicable law, candidates must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered. The Company will provide reasonable accommodations to qualified employees with disabilities or for a sincerely held religious belief, practice, or observance.