29 days old


Kelly Services
Richardson, TX 75081
**At Kelly** **** **Professional & Industrial, were passionate about helping you find a job that works for you. If you ask us, this job looks pretty great.**

We are seeking an **Internal-Auditor** for a leading Health Care Service American Company in, **Richardson, Texas**

**Hours: M F (8am 5pm)**

**Hybrid: 3 days onsite, 2 days remote**

**Contract: 3 month contract to Hire:**

**Pay: $23.31**


Under supervision, this position is responsible for effectively managing and supporting complex customer audit activities for audits of HCSC requiring in-depth knowledge of benefits and claims adjudication. Audits performed include Medical Claims, Prescription Drug, Pricing, Dental, Financial Validations, Corporate Quality, control plans audits and other special audit requests for the Texas, Montana, New Mexico and Oklahoma.


+ Control access and release of PHI, confidential, proprietary HCSC information, documentation from PAR Plans and occasionally providers to external auditors/customers. Adhere to policies and procedures.

+ Maintain rapport with Full-Service Units within the corporation.

+ Assist with audit activities for external audit groups and other plans. Support includes systems and resource training, providing general responses to questions, interpreting auditor needs, communicating auditor needs or audit questions to operational areas, other Plans, or providers, and delivering complete and accurate responses to auditor or customer. Where applicable, provide ongoing assistance until final report has been reviewed and commented upon by audit personnel.

+ Maintain audit follow-up process that entails entering external auditors' recommendations into database, following up with appropriate area to receive updates on status of changes or responses, and reporting to management.

+ Participate in database development, enhancement, and maintenance. Produce reports for internal reporting and Senior Staff.

+ Maintain valid sample for departmental claim audits. Review and analyze errors by utilizing all available system applications and processing procedures. Determine cause for errors and give feedback to areas handling claims processing functions. Document errors for tracking purposes. Ensure corrections are made to incorrect claim payments found during course of audit.

+ Support special project reviews. Determine if errors are due to system or manual processing limitations and utilize information for special projects.

+ Record special group issues and exception data. Enter in a timely manner, accurate statistics related to claim accuracy and timeliness for reporting to corporate management and customers.

+ Perform audits to validate performance reporting. Assist management in special audits requested by internal/external management. Provide consistency in audit steps as well as reporting tools.

+ Maintain knowledge of contracts, coding schemes, system applications, COB procedures, pricing and provider files, and managed care principles.

+ Communicate and interact effectively and professionally with co-workers, management, customers, etc.

+ Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

+ Maintain complete confidentiality of company business.

+ Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.


+ Knowledge of claims adjudication systems and support files.

+ Knowledge of regulations, audit policies/procedures and quality review processes.

+ Must have ability to maintain focus and have attention to detail.

+ Ability to multi-task and excel under pressure.

+ Ability to effectively prioritize and manage multiple deadlines.

+ Ability to analyze problem claims and customer service issues to determine causes and provide recommendations.

+ Interpersonal, verbal, and written communication skills.


+ Working knowledge of the following systems: CM Mouse, BAM, member benefits & accums, RTB, BlueStar, Member Inquiry, Provider Inquiry, COB Solutions, PFIN, provider contracts, Premier Pricing, Image, ECM, CMOD, VDR Reports, UCR, ACE, Prime Therapeutics, BlueSquared, PRAP, BARS/ORBM, Microsoft Teams, Alineo/Aerial, BlueCard, DocuSign, BlueSource/Procedure Flow


+ 3 years experience with group and direct-pay contracts and benefits.

+ 2 years claims adjudication and support systems experience.

+ PC proficiency to include Word, Excel, Access, Adobe Pro DC.

**What happens next**

Once you apply, youll proceed to next steps if your skills and experience look like a good fit. But dont worryeven if this position doesnt work out, youre still in our network. That means all of our recruiters will have access to your profile, expanding your opportunities even more.

For questions or more information about this role, please **apply** and contact Meleney Ho-Tong via email at

**Get a complete career fit with Kelly** **** **.**

Youre looking to keep your career moving onward and upward, and were here to help you do just that. Our staffing experts connect you with top companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in your career.

**About Kelly** ****

At Kelly, were always thinking about whats next and advising job seekers on new ways of working to reach their full potential. In fact, were a leading advocate for temporary/nontraditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live (plus, did we mention we provide a ton of benefits ?). Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.

Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kellys Human Resource Knowledge Center.
Kelly complies with the requirements of Californias state and local Fair Chance laws. A conviction does not automatically bar individuals from employment.
Posted: 2022-08-29 Expires: 2022-09-29

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Kelly Services
Richardson, TX 75081

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