The incumbent is responsible for conducting comprehensive audits of Network Providers (Institutional, Professionals and Allied) for compliance and to identify and remediate Provider fraud, waste and/or abuse. The incumbent collaborates with Management and the Provider Compliance team to implement proactive Provider billing monitoring designed to identify potential fraud, waste and abuse. The incumbent is responsible for collaborates with the Clinical Quality and Claims Operations Business Areas to identify and address fraud, waste and abuse and implement controls to address identified fraud, waste and abuse and quality issues.

Job-Specific Requirements:

• 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.
• Healthcare experience 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.

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.