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Internal Provider Auditor
@Guidehealth
[Hiring] Internal Provider Auditor @Guidehealth
Mar 26, 2025 - Guidehealth is hiring a remote Internal Provider Auditor. 💸 Salary: $21.50 per hour. 📍Location: USA.
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Role Description
As an Internal Provider Auditor, you will ensure the accuracy of the provider set ups in the internal software and access database based off client contracts. This role will be responsible for providing results and education to the Provider Operations team.
- Conduct routine monitoring and audits of providers within the internal software.
- Conduct quality audits on the provider operations department’s entries of providers.
- Audit monthly rosters as entered by provider operations.
- Understand and stay current with client contract criteria and requirements in relation to the providers.
- Monitor internal and external processes to detect any practices that, either directly or indirectly, result in fraud, abuse or waste that results in unnecessary costs.
- Run access queries as needed for administrative purposes.
- Assist claims auditors and contractual compliance auditors in additional compliance and auditing responsibilities.
- Consistently exercise independent judgment and discretion in matters of significance.
- Other duties and responsibilities as assigned.
Qualifications
- Minimum 3 years of experience in the healthcare or managed care industry, including claims/reimbursement experience, professional analytics-related experience and experience working on/managing major projects.
- Advanced to expert proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access.
- Able to problem solve, exercise initiative, and make low to medium level decisions.
- Thorough understanding of current federal, state, and local healthcare compliance requirements.
- Ability to meet deadlines and prioritize tasks; collect, correlate, and analyze data.
- Ability to work independently with minimal supervision and as part of a team.
- Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player.
- Effective written and oral communication.
Requirements
- 1-3 years auditing experience in the healthcare industry.
- Bachelor’s degree in healthcare informatics, business administration, or related field, or equivalent in experience and education.
- Ability to give constructive feedback and coaching.
Benefits
- Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
- Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
- Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
- Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
- Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
- Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
- Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
- Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.
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| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
Back to Remote jobs >
All others
All others
|
Salary
💸
$21.50 per hour
|
Remote
Location
USA
|
|
Job Type
full-time
|
Posted
Mar 26, 2025
|
️
| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
