Professional II, Service Delivery Healthcare - Cherry Hill, New Jersey
As a member of the corporate team, you’ll focus on enhancing the relationship with our clients as we provide outstanding business solution services. Within departments like Accounting & Finance, Human Resources, and Engineering, Conduent is actively staffing all teams with roles like Recovery Analyst, Client Services Specialist, and Senior Management Consultant. At Conduent, we give our employees the opportunity to further develop their career skills with the intention of growing them into leaders within the organization.
- Full Time
- Professional Development Opportunities
What will make you successful at Conduent?
Check out the traits we’re looking for and see if you have the right mix.
- Adaptable 9
- Detail-Oriented 9
- Multi-Tasker 8
- Strategic 10
- Expressive Presenter 6
- Conceptual 4
Conduent is proud to offer comprehensive and competitive benefits that reflect the value of our employees. Benefits will differ by country, please contact your recruiter for details specific to your location.
Maintaining a work/life balance is the key to success.
Department learning opportunities and company-wide digital knowledge share.
Additional resources to support employees with families.
Conduent offers programs to help advance the careers of our employees.
Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.
We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.
Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com.
I. HIT/DME/Home Health Auditor Summary:
Conduct Home Infusion Therapy, Durable Medical Equipment and Home Health audits, investigations, and other medically-related audits.
II. Primary Job Responsibilities:
• Perform field audits at provider sites by traveling to provider-sites and examining source documents such as prescriptions and patient medical records.
• Validate and document all audit findings.
• Conduct audits in accordance with audit guidelines.
• Be able to identify fraud and abuse, and document it.
• Interview providers and witnesses regarding potential fraud schemes, and document such interviews.
• Back up all findings with applicable citations in federal, state and plan rules & regulations.
Audit support activities
• Prepare for audits, making sure that the appropriate data samples are drawn, work papers are ready and pharmacies are notified.
• Conduct In-house audit tasks.
• Conduct Desk-Audits of provider data to target inappropriate therapy, questionable billing practices and aberrant behavior.
• Perform post-audit activities such as discrepancy validation and other follow up.
• Generate final reports for the client.
• Edit, validate and report audit findings.
• Provide back-up documentation during negotiation proceedings.
• Participate in administrative hearings and court proceedings when necessary.
• Conduct other audit and data analyses as required. Review data and claim information to support account management.
Education and Typical Years of Experience
III. Education and Experience:
Education / Licensure:
• Pharmacist, Certified Pharmacy Technician, or Certified Coder- DME and/or HH
Experience / Background:
• A minimum of three to five years experience in home infusion and dme experience. Home Infusion experience preferred.
• No record of felony convictions or any record of Medicaid or Board of Pharmacy sanctions for fraud, abuse or inappropriate billing.
• Intimate knowledge of pharmacy/dme/hh operations, third party billing & claim adjudication.
• Investigative or auditing experience a plus.
• Experience with word processors, spreadsheets & databases
IV. Job Skills / Requirements:
1. Thoroughness: Complete tasks 100% and pay attention to detail. Be willing to "go the extra mile" to follow through on audits, run down leads, "dig" for fraud and abuse. Properly and consistently adhere to standard auditing and investigative guidelines, document all findings and communications, and create a complete audit trail. Respond to all client requests. Let nothing "slip through the cracks."
2. Communication: With good grammar and form, cohesively & concisely communicate written audit reports and work product documentation. Be able to verbally communicate in a professional & pleasant manner in potentially combative audit situations.
3. Confidence / Self Assuredness: Must be able to handle irritated or irate audit subjects and diffuse tense situations. Must be able to operate in a sometimes-tense environment and still reach objective of completing the audit.
4. Results Orientation: Take the initiative to tweak & redirect efforts in order to make the account successful. Chase down the leads that will yield the greatest degree of fraud and recoveries.
5. Flexibility: Must adapt and be able to handle a changing schedule and ranging responsibilities.
6. Problem-Solver: Must be able to think through complex situations and fraud schemes, and identify the pattern of abuse. Must be able to work independently and get the job done with minimal supervision.
***Full-time position requiring up to 50% travel. Audit travel may require up to 4 days per week of travel depending upon location. For example - departure for audit locations on Sunday evening and return to home location on Thursday. Preference given to candidates in the South Jersey/Eastern PA or downstate NY area.
All other duties as assigned.
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form.
The Conduent difference
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