Electronic Visit Verification Auditor

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Job description

POSITION SUMMARY/RESPONSIBILITIES
Responsible for extracting, reviewing and forwarding Electronic Visit Verification (EVV) reports and information to ensure compliance with State-mandated regulations for CFHP and providers of Long Term Services and Supports (LTSS) to the STAR Kids population. Reconciles reports and transactions to identify areas of non-compliance, Claims-related issues and potential fraud, waste and abuse (FWA). Works with various departments as the first line of EVV information gathering and dissemination.

EDUCATION/EXPERIENCE
High school diploma or equivalency is required. Minimum of five years' experience in insurance, medical or managed care environment including two years of claims processing experience required. Previous auditing and/or AMISYS Advance experience preferred. Minimum of three years' experience in claims auditing required. Experience with EVV vendors and systems preferred.

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