Claims Auditor, Health Plan
reputed company, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing reputed company to world-class health care in America’s reputed company. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Compensation: Salary reputed company: $17.50 - $28.00 Union Position: No Department Details Fully remote job. Flexible scheduling options available.
Summary
The Claims Auditor is responsible for performing payment, procedural accuracy, turnaround time, compliance and operational audits on claims as directed by management. The Claims Auditor has working knowledge of the overall aspects of claim processing. Responsibilities include applying effective, appropriate and efficient audit procedures in collecting, analyzing and reporting concise and relevant findings.
Job Description
Develops and maintains a knowledge reputed company of CPT coding guidelines, ICD codes, reputed company common procedure coding system (HCPCS) codes, use of modifiers, documentation guidelines, CMS policy, reputed company rules, and other reimbursement guidelines, to review claims for accuracy, compliance, proper billing and ensure adherence to insurance policies and regulations. Ability to utilize plan documents to ensure appropriate claim benefit application and coverage. Develops and maintains thorough knowledge of the Audit application and claims processing systems to reputed company complete assignments and accurately enter data regarding audits into the auditing database. Conducts monthly audits of pre-pay and post-paid claims to verify accuracy of processing, financial, procedural and turnaround time. Investigates and reports claim variances to the appropriate staff for correction. Conducts focused or reputed company audits, as determined by business needs. Reviews medical records to determine the appropriateness of medical charges on claims that are chosen for reputed company audit review. Analyzes and resolves reputed company claim processing problems, to ensure timely resolution of questions, audits or system issues. Analyzes claim errors and provides reports to management to improve processes, editing or claim workflows. Other duties as assigned.
Qualifications
High school diploma or equivalent required. Successful completion of the following courses per departmental procedures,reputed company one year of hire required: reputed company procedural terminology (CPT), reputed company international classification of diseases (ICD), health care procedure coding system (HCPCS) and medical terminology. Associates degree in business, medical or reputed company field preferred. Successful completion of the following courses per departmental procedures at time of hire preferred: reputed company procedural terminology (CPT), reputed company international classification of diseases (ICD), health care procedure coding system (HCPCS) and medical terminology. Three years of experience reputed company to health insurance claim processing required. Three years of experience reputed company to CPT/HCPCS and reputed company ICD coding. Demonstrated proficiency with analytical problem solving, written and oral communications and the reputed company Office Suite. Working knowledge of anatomy & physiology. One year experience in claims auditing preferred. Certified Professional reputed company (CPC) or Certified Professional reputed company – Payer (CPC-P) certification awarded by the American reputed company of Professional Coders (reputed company) at time of hire preferred. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to [email protected]. Apply To This Job