800-646-9987
800-646-9987

Audit Project Manager

POSITION LOCATION: Knoxville, TN

DESCRIPTION:   Healthcare Horizons, an industry-leader in healthcare claims auditing for self-insured employers, is seeking a qualified Audit Project Manager to join our team. This individual will serve in a leadership role and contribute to the future success of Healthcare Horizons. The ideal candidate will exhibit competencies and potential to rise to an Executive Leader.

RESPONSIBILITIES:

  • Manages and performs healthcare claim audit projects for self-insured employers
  • Actively manage a portfolio of client engagements with a focus on identifying trends and anomalies in healthcare claims data
  • Advises Healthcare Horizons clients regarding reimbursement matters and strategies throughout the process, resulting in high-yield investment returns
  • Lead and develop a team of claim auditors and other service line subject matter experts to deliver exceptional client service
  • Participate in business development initiatives to include creating and maintaining business relationships with current and future clients and gaining the confidence of top-level client personnel regarding the breadth of services offered by Healthcare Horizons

REQUIREMENTS:

  • Bachelor’s degree from an accredited college/university; accounting, finance, or healthcare focus preferred
  • MBA, MPH, MHA, or other graduate level master’s degree a plus
  • 10+ years of experience in a healthcare environment – preferably with larger payer organizations (TPA), including claims adjudication supervision
  • Expertise in project management of medical claims audit services required
  • Pharmacy claims audit experience preferred
  • Thorough understanding of claims adjudication processes required
  • Willingness to travel for client projects and development opportunities
  • Sound judgment with ability to manage risk effectively
  • Superior communication skills, both oral and written
  • Traits that include: detail-oriented, flexible, and responsive
  • Ability to effectively work as a team player
  • Client-oriented work ethic, delivering high-quality results
  • Creative problem solver with a high level of strategic, analytical, and conceptual skills and a passion for helping clients

ABOUT HEALTHCARE HORIZONS

Healthcare Horizons Consulting Group, Inc. is one of the most trusted and people-centered expert healthcare claims auditing firms in the nation, focused exclusively on self-insured employers. The company is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through its 100% Difference model, recovering millions of dollars for clients’ bottom lines with uncompromising ethics and accuracy. Healthcare Horizons is committed to putting people and relationships first, offering a streamlined process with high-yield return on investment, making the clients’ financial interest its number one priority. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers, involving all national and most regional payers.

Please apply to: hhadmin@healthcarehorizons.com