Claim auditor vs senior internal auditor

Differences between claim auditor and senior internal auditor duties and responsibilities

Claim auditor example responsibilities.

• Work with department analyst to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
• Bill and prepare claims appeals for Medicare, Medicaid, and private payers.
• Review medical records and charges of hospital, ambulatory surgery and physician bills to verify CPT, ICD-9 and HCPCS codes.
• Research and determine accuracy of ICD-9 and CPT codes on CMS 1500 and UB 92 claims forms on a daily basis.
• Evaluate DRG grouping and pricing information.
• Audit all claims types for a Medicare HMO plan.
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Senior internal auditor example responsibilities.

• Schedule, plan, conduct fieldwork and report writing of audits using a COSO base audit methodology managing staff on audits.
• Manage and coordinate annual external business evaluation in conjunction with CPA consultants.
• Conduct audit reviews, document business processes, and evaluate internal controls base on Sarbanes-Oxley good governance standards and policies.
• Execute or review Sarbanes-Oxley internal controls testing for various business processes and evaluate business systems to determine their efficiency and effectiveness
• Enhance work paper standards according to IIA framework.
• Confirm that internal controls are properly map to financial statement assertions to ensure that all COSO assertions are met.
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