Internal Auditor

Conduct comprehensive claims audits to ensure compliance with fee schedules,

benefit plans, contractual obligations, service-level agreements, and claim

turnaround standards. Evaluate claims processing activities for adherence to

industry best practices, federal and state regulatory requirements,

organizational policies and procedures, provider contracts, and applicable

accreditation standards.

Analyze audit results, identify trends and areas of risk, and prepare detailed

written reports summarizing findings, root causes, and recommendations for

corrective action and process improvement. Collaborate with internal

stakeholders to monitor compliance, improve operational effectiveness, and

support regulatory readiness.

MercyCare administers a diverse portfolio of health insurance products,

including Medicaid, Exchange, ERISA, and commercial plans, and operates within

regulatory frameworks established by the Wisconsin Office of the Commissioner of

Insurance (OCI), Illinois Department of Insurance (DOI), and other applicable

federal and state agencies. The role requires a strong understanding of health

plan operations, claims administration, and regulatory compliance across

multiple lines of business.

Essential Duties and Responsibilities

* Conduct audit interviews with front line staff in all functional areas that

fall under claim operations.

* Test, create flow charts and map operational processes that touch the outcome

of claims accuracy.

* Perform routine and moderately complex audits on claims for payment integrity

in alignment with regulatory standards and timelines, business policy,

contract, appropriate coding, and system configuration.

* Research claim processing issues and errors to determine their origin and

appropriate resolution. Interacts with Operations management regarding trends

in order to improve claims processing accuracy and incorporate into training

programs, policies and procedures.

* Create audit reports to document audit findings, which will result in audit

recommendations, reports and claims audit criteria enhancements.

* Perform special project audits and reviews as requested by other departments.

Education and Experience

* Bachelor's degree in accounting or business administration preferred with

concentration in health care also preferred.

* Minimum 2 years audit experience in health care industry.

Certification and Licensure

The following certifications are preferred:

* Certified Internal Auditor (CIA) certification

* Certified Healthcare Auditor (CHA)

* Certified Public Accountant (CPA)

* Registered Health Information Administrator (RHIA)

Skills and Abilities

* Effective written and oral communication skills.

* Excellent analytical/interpretive skills.

* High degree of accuracy.

* Proficiency in application of computers and software programs such as Excel.

PAY RANGE:

$58,797.66 - $94,076.26

Mercyhealth is an Equal Opportunity Employer

[careers/]. All qualified applicants will

receive consideration for employment without regard to race, color, religion,

sex, sexual orientation, gender identify, national origin, disability, or

protected veteran status.

Mercyhealth offers competitive pay and a comprehensive benefits package

including:

* Medical, Dental, Vision

* Life & Disability Insurance

* FSA/HSA Options

* Generous, accruing paid time off

* Paid Parental and caregiver leave

* Career advancement and educational opportunities

* Tuition and certification reimbursement

* Certification Reimbursement

* Well-being Programs

* Employee Discounts

* On-Demand Pay

* Financial Education

* Annual recognition/awards events

* Partner appreciation days

* Family entertainment/attractions discount

* Community service/improvement opportunities

Click here [join-our-team/benefits/] for more

details regarding Mercyhealth Careers Benefit Information.

At Mercyhealth, we don’t simply hire people, we empower employee-partners who

are passionate about making lives better. As an integrated health system, we

deliver exceptional, coordinated across seven hospitals, 85 primary and

specialty clinics, and a team of over 7,500 professionals serving northern

Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and

culture, including:

* #1 in the nation on AARP's Best Employers for Workers Over 50

* One of Working Mother magazine's 100 Best Companies for Working Mothers

* A Top 50 Company and Top 10 Nonprofit for Executive Women