Internal Provider Auditor

Arcadia is dedicated to happier, healthier days for all. We transform diverse data into a unified fabric for health. Our platform delivers actionable insights for our customers to advance care and research, drive strategic growth, and achieve financial success. For more information, visit arcadia.io.

Why This Role Is Important To Arcadia

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.

What Success Looks Like

In 3 month

- Intermediate knowledge on the provider operations department processes

- Novice understanding of provider entry into internal software and access database

- Novice knowledge of contracts and claims processes

- Consistently performs daily, weekly, monthly audits

In 6 months

- Independently create internal quality audits

- Provide feedback to provider operations department

- Report audit findings to department managers for coaching, mentoring and tracking of audit percentages

In 12 months

- Intermediate understanding of provider contracts.

- Identify the need for higher level system enhancements as report requirements evolve and/or change.

- Bring forward new ideas, audits and processes.

What You'll Be Doing

• Conducting routine monitoring and audits of providers within the internal software
• Conducting quality audits on the provider operations department’s entries of providers
• Auditing monthly rosters as entered by provider operations
• Understanding and staying current with client contract criteria and requirements in relation to the providers
• Serving as an advanced resource and providing education to the provider operations team
• Monitoring internal and external processes to detecting any practices that, either directly or indirectly, result in fraud, abuse or waste that results in unnecessary costs
• Running access queries as needed for administrative purposes
• Assisting claims auditors and contractual compliance auditors in additional compliance and auditing responsibilities.
• Consistently exercising independent judgment and discretion in matters of significance
• Other duties and responsibilities as assigned

What You'll Bring

• 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

Would Love For You To Have

• 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

What'll You Get

• Learn the life of a Contract Management firm with Independent Physician Associations across Illinois
• Encouragement to bring ideas to the table
• Be an integral part of a desired team within Arcadia’s Value Based Services.
• Expand your claims processing knowledge to the “behind the scenes” aspect
• Opportunity to be part of a team creating automated processes to drastically improve healthcare
• Extraordinary and flexible work environment and culture
• Amazing benefits package including flexible time off
• Receive cash compensation with health, dental, and other benefits
• Be a part of a mission driven company that is transforming the healthcare industry by changing the way patients receive care
• A flexible, remote friendly company with personality and heart
• Employee driven programs and initiatives for personal and professional development
• Be a member of the Arcadian and Barkadian Community

About Arcadia

Arcadia.io helps innovative healthcare systems and health plans around the country transform healthcare to reduce cost while improving patient health. We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time. We are passionate about helping our customers drive meaningful outcomes. We are growing fast and have emerged as the market leader in the highly competitive population health management software and value-based care services markets, and we have been recognized by industry analysts KLAS, IDC, Forrester and Chilmark for our leadership. For a better sense of our brand and products, please explore our website, our online resources, and our interactive Data Gallery.

This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia's custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.