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Payment Integrity Auditor Jobs in Delaware (NOW HIRING)

WuXi AppTec

Senior Manager Accounting

Middletown, DE · On-site

... integrity, financial statement preparation, internal controls, and operational integration. This ... Act as the liaison for internal & external auditors, including supporting system-related controls ...

WuXi AppTec

Senior Manager Accounting

Middletown, DE · On-site

... integrity, financial statement preparation, internal controls, and operational integration. This ... Act as the liaison for internal & external auditors, including supporting system-related controls ...

WuXi AppTec

Senior Manager Accounting

Middletown, DE · On-site

... integrity, financial statement preparation, internal controls, and operational integration. This ... Act as the liaison for internal & external auditors, including supporting system-related controls ...

All JobsPayment Integrity Auditor JobsPayment Integrity Auditor Jobs in Delaware

Payment Integrity Auditor information

What is a payment integrity auditor?

Payment Integrity Auditors are professionals who review healthcare claims and financial transactions to ensure payments are accurate and compliant with regulations. They identify overpayments, underpayments, and fraudulent activities by analyzing billing data, medical records, and policy guidelines. Their work helps healthcare organizations minimize financial losses, improve operational efficiency, and maintain compliance with government and industry standards.

What are the key skills and qualifications needed to thrive as a payment integrity auditor?

To thrive as a Payment Integrity Auditor, you need strong analytical skills, attention to detail, and a solid understanding of healthcare claims, typically supported by a degree in finance, healthcare administration, or a related field. Familiarity with claims processing systems, data analysis tools like Excel or SQL, and knowledge of relevant regulations such as HIPAA are often required. Effective communication, investigative mindset, and problem-solving abilities are essential soft skills for identifying discrepancies and collaborating with cross-functional teams. These skills are crucial for ensuring accurate payments, detecting fraud, and maintaining compliance within healthcare organizations.

What are some common challenges payment integrity auditors face when reviewing healthcare claims?

Payment Integrity Auditors often encounter challenges such as identifying complex billing errors, staying current with frequently changing healthcare regulations, and navigating large volumes of claims data. They must also collaborate with various departments, like clinical teams and compliance, to verify the accuracy of claims and resolve discrepancies. Strong analytical skills and attention to detail are crucial for success in this dynamic and fast-paced environment.

What is the difference between Payment Integrity Auditor vs Claims Analyst?

AspectPayment Integrity AuditorClaims Analyst
Required CredentialsCertification in auditing or healthcare compliance often preferredRelevant degrees in healthcare, finance, or related fields; certifications vary
Work EnvironmentHealthcare organizations, insurance companies, government agenciesInsurance companies, healthcare providers, third-party administrators
Employer & Industry UsageFocuses on verifying payment accuracy and fraud detectionAnalyzes claims data to determine validity and processing issues

Payment Integrity Auditors primarily focus on verifying the accuracy of payments and detecting fraud, while Claims Analysts review and process claims data to ensure proper reimbursement. Both roles require knowledge of healthcare billing and compliance, but Payment Integrity Auditors emphasize auditing and fraud prevention, whereas Claims Analysts focus on claims processing and analysis.

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Payment Integrity Auditor jobs near you

Senior Manager Accounting

Middletown, DE • On-site

WuXi AppTec
Health Care and Social Assistance
Learn more about WuXi AppTecexternal

Other

Posted 14 days ago

Job description

The Sr. Manager Accounting will lead U.S. accounting operations across multiple entities, with a strong focus on accounting operations, cost accounting, general ledger integrity, financial statement preparation, internal controls, and operational integration. This role plays a critical leadership position in a major system transformation initiative, including the optimization of SAP S/4HANA, while driving process standardization for a newly established manufacturing plant.

The position is responsible for overseeing core accounting functions, ensuring compliance with U.S. GAAP and IFRS.  This individual will manage AR, AP, and General Ledger personnel and serve as a key partner to cross-functional stakeholders, including IT, FP&A, and global finance teams.

  • Lead the month-end close process including account reconciliations, trial balance, and preparation financial statements.
  • Prepare financial disclosures and supplemental reporting packages for stakeholders.
  • Implement and maintain internal controls for adequate SOX compliance.
  • Support SAP based reporting for trial balance accounts, cost centers and profit centers.
  • Responsible for cash management, cash flow monitoring, and cash forecasting.
  • Support cost accounting, including standard cost setting, inventory valuation, absorption, and variance analysis.
  • Oversight of fixed asset accounting, including capitalization, depreciation, disposals, and maintenance of the fixed asset subledger.
  • Supervision of accounts payable process including PO coding review, invoice processing, approvals, and vendor payments.
  • Serve on the finance team for SAP S/4HANA initiatives, including user acceptance testing (UAT), issue resolution, and post-go-live stabilization.
  • Coordinate with manufacturing finance team members to ensure appropriate reporting of inventory balances and reserves.
  • Interface with external tax advisors to support tax compliance activities.
  • Act as the liaison for internal & external auditors, including supporting system-related controls, documentation, and audit requests.
  • Integrate with corporate accounting to resolve trial balance issues, intercompany activity, and reporting discrepancies.
  • Assist with creating, reviewing, and deploying finance policies.
  • Support the annual budget and periodic forecast process, consolidating inputs from business partners and presenting variance analysis to leadership.
  • Perform additional duties as assigned to support finance and organizational objectives.
  • May be required to work Holidays and weekends
  • Provides department goals, staff development, and monitors team performance.
  • Supervises daily activity of the GL & AP staff members.

Experience / Education

  • Bachelor’s Degree in Accounting or with relevant work experience.
  • Minimum 10 years of relevant experience or equivalent, including prior supervisory or team leadership experience
  • CPA preferred

Knowledge / Skills / Abilities:

  • Experience working with SAP S/4HANA or similar ERP
  • Understanding of core accounting operations (GL, AP, AR, Fixed Assets, Cost Accounting, Purchase-to-Pay, Inventory)
  • Experience with internal controls
  • Proficient in oral & written communication skills
  • Proficient in Microsoft (Excel, Word, Outlook, Powerpoint)
  • Experience with LucaNet, Qlikview, and Hyperion preferred
  • Knowledge of US GAAP, and knowledge of IFRS preferred
  • Need to be able to read, write and understand English, Mandarin is a plus
  • Travel may be required

 

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, or protected veteran status and will not be discriminated against on the basis of disability

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