Blue Cross & Blue Shield of Mississippi · 5 months ago
Compliance Auditor
Flowood, MS
Full-time
Onsite
Mid Level
3+ years expBlue Cross & Blue Shield of Mississippi is committed to fostering a healthy work environment and encourages professional growth. The Compliance Auditor is responsible for conducting audits of Network Providers to ensure compliance and to identify and address instances of fraud, waste, and abuse, collaborating with various teams to implement necessary controls.
Health InsuranceInsuranceNon Profit
Responsibilities
Conducting comprehensive audits of Network Providers (Institutional, Professionals and Allied) for compliance
Identify and remediate Provider fraud, waste and/or abuse
Collaborates with Management and the Provider Compliance team to implement proactive Provider billing monitoring
Identify potential fraud, waste and abuse
Collaborates with the Clinical Quality and Claims Operations Business Areas to identify and address fraud, waste and abuse
Implement controls to address identified fraud, waste and abuse and quality issues
Qualification
Required
A Bachelor's Degree in Business or other health related field is required
Three (3) years audit experience required with experience in auditing Institutional providers or other related provider auditing is preferred
Experience in interpretation of data analysis and analytical reporting is required
PC skills required to include the Microsoft Office Suite
Effective oral and written communications skills
Preferred
Three (3) years audit experience required with experience in auditing Institutional providers or other related provider auditing is preferred
Healthcare experience preferred
Benefits
Comprehensive benefits package
Worth approximately one-third of the salary compensation
Best in the health care field
Company
Blue Cross & Blue Shield of Mississippi
Blue Cross & Blue Shield of Mississippi is a mutual insurance company that provides health insurance services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Lindsey Tong Sisneros
Executive Assistant to the Chief Financial Officer
Marc A. Dunn
Director of Provider Partnerships
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