Cost Outlier Auditor

Department: Review Operations
Staff Title: Cost Outlier Auditor
Reports to: Vice President of Review Operations
Working Conditions: Full time (M-F) Office Setting

Executive Alliance is seeking a Cost Outlier Auditor for a client in New York, NY. This is a permanent full-time position.

Position Summary: This role will be responsible for Cost Outliers Auditing

Physical Requirements:
Ø Visual and Auditory comprehension & function for written & verbal communication.
Ø Manual Dexterity with the ability to use computers and other office equipment necessary to perform assigned tasks
Ø Ability to access various settings, negotiate architectural barriers (i.e. stairs) in office and community settings
Ø Ability to use Public Transportation to commute to work

Job Responsibilities: This list does not represent all the responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of the client in general.
Ø Ability to complete all aspects of cost outlier work independently
Ø Ability to perform Medical Record Audit
Ø Maintain and update training materials as needed
Ø Maintain and update all hospital profiles as needed
Ø Assist with the training and orientation of all new staff
Ø Communicates with external liaisons on issues specific to projects and with account representatives specific to program process
Ø Perform QA of reviewers as assigned
Ø Perform various reviews such as Cost Outliers, Day Outliers, Pre and Post payment Utilization
review, Quality Reviews, and review of outpatient claims
Ø Assists the Operations department with data abstraction for special studies
Ø Works closely with the Vice President of Review Operations to ensure the completion of all assignments
Ø Attends committee meetings as assigned
Ø 10% of the time is dedicated to the Quality Management Committee as Facilitator
Ø Performs other duties as assigned

Requirements:
Ø BSN or equivalent required
Ø 2-5 years Utilization Review experience and Managed Care experience
Ø 2-5 years of Hospital experience and Medical-Surgical Experience

Qualifications:
Ø Ability to prioritize and organize workload to ensure that all assignments are completed timely
Ø Detail-oriented highly organized work skills
Ø Ability to communicate effectively both orally and in writing
Ø Excellent computer skills
Ø Commitment to continuously provide quality services to all customers
Ø Ability to train new staff to the process

Please include a resume when applying
All inquiries strictly confidential