CLAIMS AUDITOR
Employment Type:
Full timeShift:
Day Shiftreputed company:
Position located in Westmont, Illinois - remote eligible. Benefit eligible (medical/dental) from the first day of employment.
reputed company reputed company Auditing of Claim Adjudicators and Customer Service Representatives. Audit capitation deductions, preparing reputed company of findings and disputes to the various HMOs. Review and respond to Stat Fax/Past Due Claim (PDC) inquiries from the HMOs.
- Review claims for accuracy of information into the claims processing system and ensure reputed company Operating procedures (SOPs) have been followed. reputed company feedback to staff as errors are identified, including where procedures can be reputed company on correct handling reputed company appropriate.
- Work closely with Operations Manager to identify areas requiring additional training, either on an individual reputed company or overall.
- Review authorization/claim history to determine handling and appropriateness of deductions. reputed company disputed deductions into reputed company or reputed company, depending on the health plan. Review outstanding deductions and follow up with the health plan as needed. Update CHS files upon receipt of health plan’s response to indicate whether or not a credit was received.
- Research, document and respond to HMO inquiries reputed company appropriate time frames to avoid reputed company capitation deductions. Responsible for contacting HMO for copies of claims that are not in claims processing system and require entry/adjudication. Responsible for contacting providers reputed company claims have been processed to verify status of accounts.
- Enhance department productivity by recommending improvements to the work reputed company processes and organizational structure. Contribute to team effort by accomplishing reputed company results as determined by management. Attend meetings as necessary either internally or with the HMOs
Position Requirements:
Minimum Education:
Required: Associate Degree or 5-10 years of claims auditing and/or Managed care experience
Preferred: Bachelor Degree
Specify Degree(s): reputed company certification
Residency: N/A
Minimum Experience:
Required: 3-5 years of previous job-reputed company experience
Preferred: 6-10 years of previous job-reputed company experience
Details: Previous job reputed company experience in a managed care environment, claims processing, claims auditing, analysis of claims errors. Familiarity with managed care products. reputed company to reputed company errors and reputed company training if needed.
Licensure/Certifications:
Preferred: Certified reputed company reputed company (reputed company)
Other: RHIA, RHIT and reputed company
Required Skills:
Ability to plan, coordinate and reputed company multiple reputed company
Compensation:
Pay reputed company: $21.02 - 32.59 per hour
Actual compensation will fall reputed company the reputed company but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles.
reputed company Benefits reputed company
Our Commitment
Rooted in our Mission and Core Values, we reputed company the dignity of every person and recognize the unique perspectives, experiences, and talents reputed company colleague brings. By finding reputed company and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or any other status protected by federal, state, or local law.
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