Sr Audit Analyst

2 months ago


Philadelphia, United States Independence Blue Cross Full time
  • Ensure the meeting of the timeline for external audits.
  • Address the most problematic and difficult functions associated with the External Audit function to ensure timely and complete execution of external audits in accordance with sound audit practices and regulations.
  • Review all internal responses from departments for accuracy and completeness.
  • Modify responses to address properly the audience for an internal or external party.
  • Prepare audit supporting documentation.
  • Perform and develop operational audits and provide results.
  • Monitor resolution of systemic issues.
  • Serve as information resource to Audit and client management regarding audit requirements and processes.

  • BA/BS in Business Administration, Accounting, or related discipline, or equivalent knowledge acquired by on-the-job training and experience.
  • Five (5) or more years of healthcare claims audit or progressively more responsible experience in Customer Service, Enrollment, Claims, Provider Services, Medicare, Quality, or related administrative activities
  • Extensive Knowledge of audit procedures, requirements and practices related to these audits.
  • Have familiarity and Acquire a Working Knowledge Working of BCBSA guidelines for Member Touchpoint Measures (MTM), BCBSA Line Desk Level Audit (LDLA) and Multi State Plan (MSP).
  • Extensive Knowledge of all key operating systems such as Interplan Teleprocessing System (ITS) and OSCAR for eligibility, customer service, enrollment, and claim processing issues.
  • Working Knowledge of benefits coding, package types for the HMO and PPO products.
  • Working Knowledge of pharmacy services.

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