Insurance auditor vs revenue auditor

Differences between insurance auditor and revenue auditor duties and responsibilities

Insurance auditor example responsibilities.

• Manage the collection, analysis and verification of managerial payroll information to detect fraud and/or unethical practices.
• Prepare the audit report as prescribed by the insurance company within the time allow and within NCCI and ISO rules.
• Modify claim files upon customer request using proprietary software under strict HIPAA guidelines.
• Provide contract audit services to monitor the field sales force compliance with internal policies on promotional spending on healthcare providers.
• Audit paperwork to ensure products are produced within company and FDA specification.
• Develop and implement the recovery audit program for post-payment audit of dental Medicaid programs.
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Revenue auditor example responsibilities.

• Work with department analyst to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
• Respond both written and oral to taxpayer's appeals regardingadjustments and assessments to their income tax returns and/or estimate tax accounts.
• Work with revenue integrity, case management, and coding to ensure proper billing and appeals.
• Perform audits on hospitals participating in Medicaid program to ensure the hospitals are reimburse properly for services render to Medicaid beneficiaries.
• Develop user documentation, including SAAS reference manuals and training material.