Transforming the future of healthcare isn’t something we take
lightly. It takes teams of the best and the brightest, working
together to make an impact.
As one of the largest healthcare technology companies in the
U.S., we are a catalyst to accelerate the journey toward improved
lives and healthier communities. Here at Change Healthcare, we’re
using our influence to drive positive changes across the industry,
and we want motivated and passionate people like you to help us
continue to bring new and innovative ideas to life.
If you’re ready to embrace your passion and do what you love
with a company that’s committed to supporting your future, then you
belong at Change Healthcare.
Pursue purpose. Champion innovation. Earn trust. Be agile.
Empower Your Future. Make a Difference. Title: Senior Contract
Overview of Position:
The Senior Carve Out Contract Compliance Auditor works
independently under the general supervision of a Manager to
complete job responsibilities. The Senior Carve Out Contract
Compliance Auditor uses established guidelines and healthcare
experience as well as independent judgment based on nationally
recognized auditing standards, payer contractual guidelines and
payment policies to accomplish job responsibilities
What will be my duties and responsibilities in this job?
Analyze, review, and validate healthcare claim payments for
implantable medical devices
Utilize established criteria and guidelines for completing a
medical carve out claim audit
including nationally recognized
auditing standards, contractual criteria and client Implantable
Device Reimbursement policy.
Communicate audit determinations in writing to the client,
provider and appropriate business departments as determined by
internal departmental workflow policies
Evaluate client reimbursement policy and contractual language as
it pertains to claims payment on implantable medical devices.
Research government and manufacturer websites for updated
implantable device criteria for the Implant Reference Library
Review any additional information sent by the provider to
substantiate an audit appeal
Communicate with the Manager regarding audit appeal rates,
auditing issues that arise from appeals, and the need for any
change in audit process.
What are the requirements needed for this position?
Registered Nurse with current active license and clinical review
Knowledge of healthcare contracts
Demonstrate knowledge of healthcare billing, coding and
reimbursement guidelines (Revenue Code, CPT4, HCPCS, and
Demonstrate knowledge of implantable medical devices as they
relate to surgical procedures
Ability to use software, hardware, and peripherals related to
Proficient in the use of Word and Excel
What other skills/experience would be helpful to have?
Demonstrate ability to prioritize tasks and work well with a
Demonstrate ability to adapt to changing guidelines, criteria,
Demonstrate professional writing skills and strong verbal
Strong research skills
Knowledge of FDA criteria in regards to Implementable Surgical
What are the working conditions and physical requirements of
General office demands.
How much should I expect to travel?
Occasional travel may be necessary.
Employees in roles that require travel will need to be able to
qualify for a company credit card or be able to use their own
personal credit card for travel expenses and submit for
Join our team today where we are creating a better coordinated,
increasingly collaborative, and more efficient healthcare
Equal Opportunity/Affirmative Action Statement
Change Healthcare is an equal opportunity employer. All
qualified applicants will receive consideration for employment
without regard to race, color, religion, age, sex, sexual
orientation, gender identity, genetic information, national
origin, disability, or veteran status. To read more about
employment discrimination protections under federal law, read EEO
is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the
supplemental information at
If you need a reasonable accommodation to assist with your
application for employment, please contact us by sending an email
to email@example.com with "Applicant
requesting reasonable accommodation" as the subject. Resumes or CVs
submitted to this email box will not be accepted.
to view our pay transparency nondiscrimination policy.
Change Healthcare maintains a drug free workplace and conducts
pre-employment drug-testing, where applicable, in accordance with
federal, state and local laws.