Job description

Our client, a well-known and reputable Managed Care Organization in the Los Angeles/Orange County area is seeking a Claims Auditor to join their growing team. This organization offers a competitive salary, full benefits, and much more!

Salary: $30 - $33/hr

Location: Montebello, CA

Schedule: Monday - Friday, (6am – 3pm, 7am – 4pm, or 8 am– 5pm)

1 – 2 days per week in office (HYBRID). after Initial training***

*** Initial training will be onsite at Montebello. Training will vary from person to person and may take as little as two weeks and as long as a couple of months.

Must be COVID vaccinated -

Summary

This position does not require direct patient interaction. The Claims Auditor will be responsible for the accurate review and auditing of claims that are adjudicated by the system and the Claims Examiners. The auditor will suggest process improvements to management and act as a resource of information to all staff. The Claims Auditor will identify overpayments and coordinate with the Claims Recovery Unit.

Responsibilities

• Audit claims as it relates to the appropriate Federal and State regulations based on the member’s Line of Business.
• Read and interpret DOFRs as it relates to the claim in order to ensure that group is financially at risk for payment.
• Read and interpret provider contracts to ensure payment accuracy.
• Read and interpret Medi-Cal and Medicare Fee Schedules.
• Utilize auditing tools to identify and determine accuracy of claims payments (prospectively and retrospectively).
• Coordinate with internal departments for any issues relating to provider, fee schedule, eligibility, authorization, or system issues.
• Complete appropriate documentation for tracking/trending of data in order to identify system issues and remediation.
• Provide regular feedback to the Claims Management team concerning process improvement opportunities, or any training opportunities relative to adequacy of file investigation/ development in advance of the recovery effort.
• Coordinate with the Recovery Department for any identified overpayments.
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
• Other duties as assigned.

Qualifications

• HS Diploma or GED
• 3+ years of Claims Processing experience
• Must be knowledgeable of Medi-cal regulations
• Preferred knowledge of Medicare and Commercial rules and regulations
• Knowledge of medical terminology
• Must have an understanding to read and interpret DOFRs and Contracts.
• Managed Care concepts
• Must have strong organizational and mathematical skills.

Job Type: Full-time

Pay: $30.00 - $33.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• Do you have experience with private insurances, commercial insurances, and Medical/Medicare?
• Are you well-versed in medical terminology?
• We will need to see at minimum of 3 years with the following specific job title, Claim Auditor or 5 years as a claims examiner. Will I see that listed on your resume?

Work Location: In person

abouteureka.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, abouteureka.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, abouteureka.com is the ideal place to find your next job.