Claims Auditor
Health Source MSO
Alhambra, CA
JOB DETAILS
SALARY
$30 Per Hour
JOB TYPE
Full-time, Employee
SKILLS
Adjudication, Auditing, Billing, Claims Management, Claims Processing, Communication Skills, Computer Skills, Content Management Systems (CMS), Current Procedural Terminology (CPT), Data Collection, Diagnosis-Related Group (DRG), Health Plan, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Providers, Homeland Security, ICD-10, Identify Issues, Managed Care, Medi-Cal, Medicare, Microsoft Excel, Microsoft Outlook, Microsoft Word, Multitasking, Pricing, Quality Management, Regulations, Reimbursement, Specimen Collection, Team Player, Time Management, Typing, Writing Skills
LOCATION
Alhambra, CA
POSTED
5 days ago
Job Description:
Claims Auditor will be responsible for auditing claims processed by Claims Examiners.
Responsibilities include, but not limited to:
- Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including:
- Contractual agreement rates
- Health Plan procedures
- Medicare and Medi-cal reimbursement
- Claims processing guidelines
- Evaluate claims based on DMHC and DHS regulations
- Respond and resolve providers’ and health plans’ inquires in a timely manner
- Check for adjudication errors and present them to respective Examiner
- Present recommendations for improvements for Examiners
- Identify escalating issues to appropriate team(s) and management
- Monitor aging claims with reports to maintain timeliness
- Maintain quality and productivity standards
- Maintain a minimum audit-accuracy rate
- Participate in special projects
- Collect claim sample data to perform audits
- Reports and works closely with Claims Manager
Qualifications:
- Bachelor’s degree in related field or AA degree with related experience
- Must have at least 5 years of applicable healthcare claims adjudication experience within a managed care industry
- Must be familiar with ICD-10, HCPCS, CPT coding, APC, ASC, and DRG pricing.
- Must be familiar with facility (UB-04) and professional (CMS-1500) claim billing practices.
- Must have good written and communication skills.
- Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment.
- Computer literacy required, including proficient use of Microsoft Word, Excel, Outlook, and EZ-CAP. EZ-CAP 6X is a plus.
- Typing skills of a least 40 wpm.
Benefits:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- 401K Matching
- Paid Time Off
About the Company
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