Amplify Health
Healthcare
Senior,ClaimsAudit
“Senior, Claims Audit at Amplify Health. Skills: Claims auditing, Fraud detection, Risk assessment, Data analytics. Conduct reviews of healthcare claims. Assess clinical appropriateness”
What You'll Achieve.
Safeguard healthcare scheme integrity; Optimise healthcare spend; Strengthen claims governance
Industry & Context.
Data-driven; Structured analysis
What They're Looking For.
Must Have
5–8 years of experience in claims auditing, knowledge of medical coding systems, knowledge of reimbursement policies, Bachelor’s degree in healthcare or related discipline
Nice to Have
Experience in healthcare payer environments, Experience in insurance environments, Experience in managed care environments, Certification in Fraud Examination, Certification in Clinical Coding, Certification in Audit
What You'll Do.
Conduct reviews of healthcare claims
Assess clinical appropriateness
Assess coding accuracy
Assess policy compliance
Identify patterns of fraud
Identify patterns of waste
Identify patterns of abuse
Identify billing anomalies
Analyze provider behavior
Analyze utilization trends
Uncover suspicious activities
Uncover systemic risks
Partner with fraud investigation teams
Support case development
Support case resolution
Prepare audit reports
Provide recommendations
Engage with healthcare providers
Engage with industry bodies
Engage with internal stakeholders
Clarify audit findings
Resolve discrepancies
Lead discussions on billing practices
Lead discussions on coding standards
Lead discussions on policy interpretation
Provide advisory on claims governance
Provide advisory on risk mitigation
Identify emerging risks
Translate data into insights
Improve claims controls
Improve cost management
Produce audit reports
Produce executive summaries
Design controls to mitigate leakage
Design controls to reduce fraud
Enhance audit methodologies
Enhance audit processes
Contribute to detection models
Contribute to rule engines
Lead audit engagements
Manage multiple priorities
Ensure timely delivery
Ensure high-quality outputs
How You'll Work.
Team & Collaboration
Internal stakeholders; Fraud investigation teams; Healthcare providers; Industry bodies
Communication Scope
Stakeholder engagement; Executive summaries
Process & Methodology
Project management, Manage multiple priorities, Timely delivery, High-quality outputs
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