Auditing, Background Investigation, Claims Processing, Communication Skills, Contract Analysis, Current Procedural Terminology (CPT), English Language, Financial Planning, Health Plan, Healthcare, High School Diploma, ICD-9, Insurance Claims, Mathematics, Medical Terminology, Microsoft Product Family, Multitasking, Operational Audit, Organizational Skills, Policy Development, Presentation/Verbal Skills, Systems Administration/Management, Writing Skills
JOB SUMMARY:
Responsible for performing planned financial, network and operational audits and/or special reviews. The audits will provide verification of compliance with established controls, policies, plans and procedures as well as adequacy and effectiveness of the system set up.
KEY REQUIREMENTS:
- Audit all networks.
- Audit all operational departments.
- Track and trend all errors found during the audit process and supply feedback to management.
- Establish training needs for operational departments identified during the audit process.
- Distribute monthly audit reports to management.
- Perform other job-related duties as assigned.
QUALIFICATIONS:
- Ability to perform detailed mathematical calculations and understanding of mathematical concepts and abstract reasoning.
- Ability to manage multiple tasks simultaneously.
- Successful completion of Health Care Sanctions background check.
- Possess strong oral and written communication skills.
- Working knowledge of claims processing systems.
- Ability to converse and write fluently in English.
- Knowledge of claims processing manuals and health benefit designs/booklets.
- Ability to interact with personnel at all levels.
- Ability to read and have a clear understanding of claims processing manuals, medical terminology, ICD9, CPT4 coding, perform claims processing procedures and interpret contractual agreements.
- Highly organized and attentive to detail.
- Proficient in Microsoft applications.
EDUCATION/EXPERIENCE:
- High School diploma or equivalent; associate degree preferred.
- 2 to 4 years of experience working with claims insurance, quality review, auditing or training required.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin