Leads day-to-day activities of the audit team, creating and managing workflow assignments, establishing priorities, and serving as a resource for training to lower-leveled audit associates. Operates as the SME (subject matter expert) for a specific line of business as assigned and documents workflow processes. Collaborates across business lines through the facilitation of meetings. Manages vendor relationships with contracted vendors. Investigates potential fraud and over-utilization by performing the most complex medical reviews via prepayment claims review and post payment auditing. Conducts provider meetings to discuss audit findings and appeals for the most complex audits. Researches claims payment methodologies and fee schedule pricing of claims. Adjusts and re-prices claims per audit findings. Assists in resolving contractual issues with providers and in reviewing audit process policy and procedures. Prepares and analyzes various reports to demonstrate recoveries and potential issues with providers. Assists manager with reimbursement/audit initiatives as identified. Supports enterprise initiatives and develops educational materials for internal staff and providers. Minimum Requirements:Requires a BA/ BS degree and a minimum of 5 years of experience in a related field, including provider audit reimbursement, and analytics; project management and leadership experience; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities and Experiences:Minimum of 2 years of claims review experience highly desired. Experience related to medical coding, including coding certification, nursing licensure, and/or a clinical background, is strongly preferred. Job Level:Non-Management Exempt. Workshift:1st Shift (United States of America)