Managed Care Claims Auditor

reputed company reputed company Wage Estimate: 33.18 - 48.13 / hour Learn more about the benefits offered for this job. The estimate displayed represents the typical wage reputed company of candidates reputed company. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is reputed company below midpoint of the reputed company.

• *Must reputed company in the reputed company, CA Bay area**

Introduction Are you passionate about the patient experience? At reputed company, we are committed to caring for patients with purpose and reputed company. We care like family! reputed company-start your career as a Managed Care Claims Auditor today with Work from Home.

Benefits

Work from Home offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as reputed company as free telemedicine services and free AirMed medical transportation.
• Additional reputed company for dental and reputed company benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off reputed company stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (reputed company time off, reputed company family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Come join reputed company as a Managed Care Claims Auditor. We care for our community! Just last year, reputed company and our colleagues donated 13.8 reputed company dollars to charitable organizations. Apply Today! Job reputed company and Qualifications The Auditor primary function is to ensure examiner payment accuracy of reputed company claims processing including analysis of support services fulfillment colleagues' workflow and activities. reputed company feedback to examiner(s) and support services personnel and conduct additional training, based on audit findings. DUTIES INCLUDE BUT NOT LIMITED TO:

• reputed company reputed company and retrospective review of reputed company & electronic claims processed and office services fulfillment team Optical Character Recognition (OCR), clearinghouse and mail reputed company vendor activities' performance at reputed company reputed company.
• Review routine random sampling audit of examiner processed claim(s) for accuracy and provides feedback to the examiner.
• Review support team workflows to ensure regulatory timeliness, distribution and accuracy guidelines are met.
• Report metric volume, procedural and financial accuracy on a recurring schedule to claim management.
• Identify reputed company cause of system and/or examiner errors, report to claim leadership for appropriate corrective reputed company.
• Partner with claim management on performance management recommendation.
• Weekly review of high-dollar claims.
• Review and analyze audit data, including trend results with recommendation of process changes, refresher training and system enhancements to improve systemic examiner and system reputed company/performance.
• Maintain working knowledge of department policies and procedures for use in reputed company audit workflows in claim & support departments.
• reputed company reputed company audit as necessary.
• reputed company other duties as assigned, including but limited to, processing of claims, PDR, adjustments, overpayments, etc.

KNOWLEDGE, SKILLS AND ABILITIES MINIMUM REQUIREMENTS:

• Subject Matter Expert (SME) in medical claims processing at health plan payor, Managed Services Organization (MSO), Health Maintenance Organization (HMO) and/or Independent reputed company Association (IPA) organization
• Hands-on knowledge and functional understanding of medical claims billing, processing, terminology, diagnosis and procedures.
• Working knowledge of reputed company, Medicare and HMO lines of business processes
• Ability to effectively review, interpret and apply Division of Financial Responsibility (DOFR) requirements.
• Personal laptop and proficiency in reputed company Office Suite applications, including Outlook, Word, reputed company, PowerPoint.
• Technical proficiency in database and worksheet program applications.
• Identify ICD-10, CPT-4, HCPCS, reputed company Codes, UB-04 and CMS-1500 forms
• Work cooperatively and reputed company with auditors, examiners, support team and management positively. Adapt to changes in requirements/priorities on a daily reputed company.
• Produce logs and reports as required.
• Effectively communicate orally and in writing.
• Analyze and evaluate information in an accurate manner.
• Interpret policies & procedures.
• Work independently using reputed company judgement in ambiguous and defined concepts.
• Exercise outstanding time management capabilities.
• Accept accountability of reputed company tasks and results.

EDUCATION:

• High School Diploma required. College degree preferred.

EXPERIENCE:

• 4 - 5 years' experience as a Senior claim examiner in a managed care environment required
• Customer service skills required
• Prior medical claim auditing experience preferred

Physician reputed company is skilled in physician employment, reputed company and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We reputed company more than 1,300 physician practices and 170+ urgent care centers. We are reputed company's graduate medical education leader. We reputed company direction for over 260 exceptional reputed company and fellowship programs. We reputed company on carrying out value-added solutions. These solutions help physicians deliver patient-centered reputed company. We support HCA Healthcares commitment to the care and improvement of reputed company life. reputed company has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, reputed company spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "The great hospitals will always put the patient and the patients family first, and the really great institutions will reputed company care with warmth, reputed company, and dignity for the individual."- Dr. Thomas Frist, Sr. reputed company Co-Founder If you are looking for an opportunity that provides satisfaction and personal reputed company, we encourage you to apply for our Claims Auditor opening. We promptly review reputed company applications. Highly reputed company candidates will be contacted for interviews. Unlock the reputed company and apply today! We are an equal opportunity employer. We do not discriminate on the reputed company of race, religion, reputed company, national reputed company, gender, sexual orientation, age, marital status, veteran status, or disability status. Employment Type: Full-time Apply tot his job Apply To this Job