Claims Auditor

Position Summary The Claims Auditor assists in the Claims Department by analyzing procedures, policies and reports; ensures appropriate payment of claims and maintenance of the claims system as necessary.

Specific Skills Needed Knowledge of HMO/or IPA operations; medical terminology; ICD-10, RVS, and CPT coding knowledge; knowledge of Medicare and Medi-Cal guidelines; 10-key skills by touch; excellent communication skills; knowledge of system applications; ability to function effectively under time deadlines; strong organizational skills.

Required: Formal training will be indicated by a high school diploma or equivalent; four years medical claims processing.

Preferred Department Management to list.

Duties & Responsibilities Safeguards and preserves the confidentiality of patient’s protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital and departmental policies. Ensures a safe patient environment and adherence to safety practices per policy. With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant other when administering care. Assist the Claims Director in the training and education of the Claims department staff Coordinate the generation and review of claims audit, status and pending claims reports ensuring authorized claims are paid in accordance with company guidelines Investigate, process and track payment adjustments including refunds, overpayments and underpayments Act as a confidential and professional resource for group providers and other staff. Act as a resource for providers, members, insurance carriers, attorneys and co-workers, researching and responding to questions in a timely manner Create, maintain and generate system reports Interface with the Claims Director to ensure claims processing functions meet legal and contractual requirements with regards to health plan audits Prepare and present weekly and monthly reports reflecting staff and departmental quality statistics Review and audit member liability denials and Provider Dispute Resolution claims to ensure compliance with regulatory requirements and passing audit scores from health plans Perform other duties as assigned

Recruiter Details: Vishakha Singh Sr IT Recruiter E-mail:

vishakha.singh@ustechsolutionsinc.com Internal id- 25-54852

About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit

www.ustechsolutions.com

.

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.