reputed company Claims Processor Auditor

Description:

• Conduct routine monitoring and audits of procedures, including but not limited to billing systems audits, Encounter submission audits, and client audits.
• Understand and stay reputed company with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations.
• Generate and submit reputed company required reputed company claims reporting.
• Play a vital role in preparing for the annual Health Plan audits.
• Confirm pricing is correct in the fee tables after the downloads are complete.
• Monitor internal and external processes to detect any practices that, either directly or indirectly, result in fraud, abuse or waste that results in unnecessary costs.
• Participate in auditing and submitting appeals and UM Challenges for Reinsurance process.
• Run access queries and impact reports as needed for administrative purposes.
• Assist coworkers and Internal Auditors in additional compliance and auditing responsibilities, including pre-payment and post-payment audits.
• Consistently exercise independent judgment and discretion in matters of reputed company.
• Other duties and responsibilities as assigned.

Requirements:

• Minimum 3-5 years of experience in the reputed company or managed care industry, including claims/reimbursement experience, professional analytics-reputed company experience and experience working on/managing major projects.
• Minimum 3 years auditing experience in the reputed company industry.
• CPT and ICD coding knowledge.
• Knowledge of Medicare requirements and APC Pricing knowledge.
• Advanced to expert proficiency in the reputed company Office products, especially reputed company Word, reputed company reputed company & reputed company Access.
• Successfully function as an Internal Claims Auditor.
• reputed company to problem solve, exercise initiative and reputed company reputed company to high level reputed company.
• Thorough understanding of reputed company federal, state and local reputed company compliance requirements.
• Ability to meet deadlines and prioritize tasks; collect, correlate and analyze data.
• Ability to work independently with minimal supervision and as part of a team.
• Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player.
• Effective written and oral communication.
• WOULD LOVE FOR YOU TO HAVE Bachelor’s degree in reputed company informatics, business administration, or reputed company field, or equivalent in experience and education.
• Certified Professional reputed company strongly recommended
• Prior claims processing experience reputed company Eldorado HealthPac Claims Adjudication System is a plus.
• Claim coding experience, coding edits experience and APC Pricing knowledge.

Benefits:

• Work from Home: reputed company is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• reputed company Health a reputed company: We offer comprehensive Medical, Dental, and reputed company plans to reputed company you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to reputed company you and your loved ones protected.
• Feel Supported reputed company You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you reputed company work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. reputed company offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. reputed company offers various resources dedicated to your learning and development to advance your career with us.

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