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MSI Health Service Auditor

Posting Date: Nov 19, 2021

Location: Dartmouth, Nova Scotia, CA, B3J 3C6

Company: Medavie Blue Cross

 

Job Title: MSI Health Service Auditor  
Department: Government & Corporate Secretary   
Competition: 74802  
Internal/External: Internal/External  
Employment Type: Fulltime, Permanent  
Location: Dartmouth, NS  
Salary: Competitive Salary  
Reports To: Team Leader  
Closing Date: December 5, 2021  
   

 

 

Position Summary
Reporting to the Team Leader, and working in a team environment, the MSI Health Services Auditor is responsible for all activities associated with provider billing audits, under the MSI Medicare, Optometric and Ancillary Programs. This work includes analyzing audit material gathered during an audit and working closely with the Medical Consultant on the evaluation and results.  This position is also responsible for the production of audit reports.  The MSI Health Service Auditor is required to maintain current knowledge with respect to policy and procedure changes.  The Health Services Auditor will liaise closely with Leadership, internal partners, as well as the client on audit related matters.  
This position will require travel throughout the province.

 

Key Responsibilities
•    Conduct billing audits of provider records to determine accuracy of claims billed to MSI.  Activities include the following:
•    Prepare pre-audit material, including claims data reports.
•    Schedule, co-ordinate and conduct provider audits including on-site audits in providers offices, hospitals, and/or nursing homes.  
•    Provide education to providers and respond to enquiries  regarding audit.
•    Analyze audit material collected considering medical content, documentation and assessment rules; calculate recoveries, communicate with provider
•    Liase with Medical Consultants as required to review audit material.  Prepare and present audit material to Medical Consultant and Leadership as required.
•    Assist in the development of annual audit plans and associated audit procedures; acquire a good working knowledge of health service code adjudication rules, policies, procedures and processes.
•    Conduct contract evaluations of alternative funding/payment plans to ensure providers are complying with contract requirements
•    Assist with provider risk analysis to identify those providers requiring an audit of their billing practices.
•    Communicate with Department of Health and Wellness, providers, and internal staff regarding  MSI audit related matters.
•    Represent MSI at meetings with the Department of Health and Wellness and other partners and stakeholders on audit related matters as necessary.
•    Participate in internal and external working groups when required
•    Conduct audit related presentations when requested.

 

Required Qualifications:

 

Education:    College or University degree in Business or Finance

 

Work Experience:    Experience working in a medical related field and /or audit environment either through previous work experience or formal training.
 

Other Qualifications:    Excellent communication, organizational and decision making skills.  Excellent report writing skills are considered an asset.  Ability to manage conflicts and handle high stress situations.  Complete knowledge of and familiarity with medical records management, medical conditions, treatments and procedures.   An understanding of MSI adjudication rules, policies, procedures and processes would be an asset
 

Computer Skills:    Proven analytical skills with the ability to work with data samples to manipulate and draw inferences from large data sets.  In addition to solid knowledge of computerized database systems and query tools.
 

Language Skills:    English – written and spoken.  French would be considered an asset.
Core Competencies
 

Knowledge:    Demonstrates complete understanding of skills and knowledge required to fulfill key aspects of the job.  Works independently or with minimal help to resolve day to day issues or problems and suggests improvements.  Demonstrates knowledge of customer needs and various processes and procedures in own work area as well as a general understanding of processes in related work areas.
 

Analytical Thinking:    Demonstrates a willingness to consider new and innovative approaches.  Uses business knowledge and experience to solve routine problems and ask questions to determine the sources of the problem.  Solves more complex problems with minimal supervision.  
 

Communication Skills:    Communicates clearly and confidently verbally and in writing to a variety of audiences.  Listens to direction and instruction and accurately restates them for clarity to ensure full and mutual understanding.
 

Customer Orientation:    Seeks information about internal and external customers and their business needs to ensure these needs are met with a commitment to excellence and quality.  Proactively manages and monitors customer satisfaction while providing friendly and courteous customer service.
 

Execution and Organizational Skills:    Able to set and work through a list of priorities in a timely manner.  Sets clear personal objectives
Team Work:    Works collaboratively to achieve common objectives by asking for feedback, sharing information and encouraging others to share information.  Helps others with problems without being asked. Demonstrates an understanding of how the job contributes to the overall work unit.
 

 

We would like to thank all candidates for expressing interest.  Please note only those selected for interviews will be contacted.

Medavie Blue Cross is an equal opportunity employer.

In order to keep our employees, candidates, and community safe during the COVID-19 pandemic, the majority of our employees are working from home within Canada. All interviewing, onboarding and most work takes place remotely at this time. For those employees who must work in our offices, we have taken every precaution to ensure the health and safety of our people by providing strict protocols/practices to meet legislated client and company needs, as well as modifications to the worksites to mitigate the risks for everyone's protection.

At Medavie, everything we do is to improve the wellbeing of Canadians.  We have implemented a COVID-19 Vaccination Policy as part of our ongoing efforts to protect the health and safety of our employees, partners, plan members and the communities where we live and work.  Proof of full vaccination is required to work onsite at any Medavie Workspace. 


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