Health Services Auditor (14 Month Term)

Position Type:

If youre looking for a fulfilling career that can make a real difference in your life and the lives of others youve come to the right place.

As a national health solutions partner we put people first in everything we do and that begins with our team of 8000 professionals who bring a cross-section of diverse life experiences and career expertise to Medavie. By collaborating and innovating together our employees are creating industry-leading solutions in insurance primary care and emergency medical services that impact millions of lives in Canada each year.

Our mission is to improve the wellbeing of Canadians so that every life can be lived to the fullest and its reflected in our award-winning culture. We celebrate individuality and value the diverse perspectives and skills our employees contribute. We go beyond providing competitive pay and comprehensive benefits to offer opportunities for personal and professional growth flexible work options meaningful experiences and supportive leadership. Medavie is where employees can be their best selves feel they belong and achieve their full potential. Be part of it by applying for a position with us today.

The position of Health Services Auditor reports to the Team Leader NSPP. The audit team performs all activities associated with post payment monitoring under the Provincial Programs to ensure compliance to the Nova Scotia provider billing policies. Specifically the team is responsible for the collection and review of audit material including clinical records to determine the appropriateness of claims billed for payment; communicating audit findings and associated recoveries with providers; and conducting risk analysis to determine providers to be audited.

This position will require travel throughout the province.

Key Responsibilities:

• Prepare pre-audit material based upon type of audit to be conducted

• Schedule and co-ordinate on-stie and remote audits to ensure efficient use of resources

• Analyze audit material collected considering content documentation and program rules.

• Educate providers regarding audit requirements. Respond to enquiries from providers regarding audit related matters

• Prepare reports detailing audit findings. Discuss audit findings and recoveries with providers. Prepare and present case material to support the audit and appeal process.

• Prepare and present audit material to leadership as required.

• Maintain a computerized database of audit activity.

• Liaise with Medical Consultants to review audit material.

• Conduct contract evaluations of provider contracts to ensure providers are complying with contract requirements.

• Review risk analysis to identify providers that require audits.

• Assist in the development of audit plans and associated audit procedures including assessment of risks defining priority areas for deployment of audit resources and specification of associated performance standards.

• Communicate with Department of Health providers and internal staff regarding audit related matters.

• Attend ad hoc and regularly scheduled meetings with the Department of Health and other allied bodies on audit related matters as necessary.

• Acquire a good working knowledge of the policies and procedures associated with the Provincial Programs.

Required Qualifications:

Education: University or college diploma in a Health-Related Discipline and/or Financial Services Related Discipline is considered an asset or equivalent work experience.

Experience: Experience working in a medical related field and/or audit environment either through previous work experience or formal training.

Language: English is required bilingualism (English and French) would be considered and asset.

Knowledge and Skills:

Knowledge:

• A background in health insurance and training industry with the functional and technical knowledge and skills to do the job at a high level of achievement.

Analytical Thinking:

• High attention to detail using logic and good judgment in decision making for when different situations and skills may call for different approaches.

• Proven analytical skills involving large volumes of data in addition to solid knowledge of computerized database systems and query tools.

Communication Skills:

• Possess superior communication skills (oral written listening) and delivers information clearly and confidently.

• Demonstrates the ability to tailor information and delivery to suit the nature of the material audience and situation.

Customer Orientation:

• Builds rapport constructive and effective relationships and spends extra effort to put others at ease. Can understand where our clients are coming from and place the appropriate level of urgency as required.

Execution and Organizational Skills:

• Prioritizes and effectively copes with change.

• Ability to organize work and information in a well thought out manner to deliver on specific tasks and reporting deadlines.

• Exhibits high levels of energy and perseverance in the pursuit of established goals.

Teamwork Skills:

• Demonstrates an understanding of how the job contributes to the overall work unit and takes the initiative to help with problem situations.

• Easily gains trust and support of peers encourages collaboration and is composed.

• Seeks and is receptive to feedback and enjoys working with people both as part of a team and one-on-one.

#CBM1

Pay Grade:

The Base Pay range may vary depending on the successful candidate or other relevant job-related factors such as knowledge skills qualifications experience and education/ addition to Base Pay eligible Medavie employees may participate in various performance-based incentive programs. Payments under these programs are discretionary and subject to both individual and organizational results.

We believe our employees should reflect the communities we serve and welcome applications from candidates of all backgrounds. To provide the best experience possible we will support you with accommodations or adjustments at any stage of the recruitment process. Simply inform our Recruitment team of your needs. We are committed to making sure recruitment retention advancement and compensation are fair and accessible while following all relevant human rights and privacy laws. We appreciate everyone who has shown interest in this position. Only those selected for an interview will be contacted.

Our recruitment process may involve automated tools including AI to assist in screening applications.

If you experience any technical issues throughout the application process please email: .