In my previous role, I discovered a discrepancy in the claim amount during a routine audit. The claim had been overpaid by $500 due to a miscalculation in the medical codes. I immediately flagged the issue, collaborated with the provider to correct the codes, and ensured the overpayment was recovered. This experience honed my attention to detail and my ability to navigate complex claim processes.

I prioritize tasks based on the urgency and potential impact of the claims. For instance, I prioritize audits that involve high-dollar claims or those with a history of errors. I also use a task management system to track deadlines and allocate time efficiently. This approach ensures that critical issues are addressed promptly while maintaining a high standard of accuracy across all audits.

I stay updated on the latest regulatory changes and incorporate them into my audit processes. I also conduct regular training sessions for the team to ensure everyone is aware of the requirements. During audits, I cross-reference claims with the relevant regulations and guidelines to ensure full compliance. This proactive approach minimizes risks and ensures that our audits are thorough and compliant.

I approach disputes with a collaborative mindset, aiming to understand the provider's perspective while maintaining the integrity of the audit. I provide clear documentation and evidence to support my findings. If a disagreement persists, I escalate the issue to a senior auditor or involve a mediator to facilitate a resolution. This approach ensures that disputes are resolved fairly and efficiently.

I leverage data analytics to identify patterns and trends in claim data that may indicate potential issues. For example, I use statistical analysis to flag claims with unusually high costs or frequent errors. This allows me to focus my audits on areas with the highest risk, improving efficiency and accuracy. Additionally, I use data visualization tools to present audit findings clearly, helping stakeholders understand the data and make informed decisions.