Risk Pool Auditor

3 weeks ago


Los Angeles, United States MedPOINT Management Full time
Job DescriptionJob Description

Salary Range: $26 - $29

 

Summary

Responsible for reviewing claims paid in Shared and Dual Risk Pools, monitor and maintain the files audited, submitted for disputes and responses from outside entities. Responsible for the accuracy and integrity of the Hospital claims paid by MPM. Ensures interpretation and compliance with the appropriate Division of Financial Responsibility (DOFR), while developing and maintaining a working knowledge of the statues and laws relating to billing, claims payments and claims adjudication. Prepare files for claims dispute submission to health plans and other outside entities. Works under the supervision of the Auditing & Recoveries Supervisor.

 

Duties and Responsibilities

· Review, Track and Analyze Risk Pool Summaries.

· Audit Risk Pool Detail and submit disputes to Health Plan or Cap Hospital.

· Review Response from Health Plan or Cap Hospital for accuracy.

· Ensure that disputes agreed to are credited back to the pool.

· Ensure pool settlements are paid timely.

· Cross train on other tasks and reporting requirements within the unit.

 

Minimum Job Requirements

· High school diploma or GED

· At least 2 years’ experience with Hospital claims processing and/ or billing.

· AAPC Coding certification highly preferred.

 

Skill and Abilities

· Strong written and oral communication skills.

· Knowledge of medical terminology and medical claims coding

· Ability to analyze, interpret and prepare DOFR’s and reports.

· Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher

· EZ-CAP® knowledge a plus.



  • Los Angeles, United States City National Bank Full time

    Overview: **AUDITOR II-CREDIT RISK** **WHAT IS THE OPPORTUNITY?** The auditor will work within a team and on occasion as an individual contributor on routine audit assignments testing internal controls and ensuring compliance with bank policies, procedures, and regulatory requirements. Assigned to one of the following areas: - Financial, operational and...


  • Los Angeles, United States MedPOINT Management Full time

    Job DescriptionJob DescriptionSummary: The Hospital Risk Pool Financial Analyst Supervisor leads, manages and oversees the Team of Hospital Risk Pool Financial Analyst in preparation and delivery of financial, clinical, and business analysis. This includes the accurate quantification and measurement of clinical outcomes. In addition, other key...


  • Los Angeles, United States MedPOINT Management Full time

    Job DescriptionJob DescriptionSummary: The Hospital Risk Pool Financial Analyst Supervisor leads, manages and oversees the Team of Hospital Risk Pool Financial Analyst in preparation and delivery of financial, clinical, and business analysis. This includes the accurate quantification and measurement of clinical outcomes. In addition, other key...


  • Los Angeles, United States MedPOINT Management Full time

    Job DescriptionJob DescriptionSummary: The Hospital Risk Pool Financial Analyst Supervisor leads, manages and oversees the Team of Hospital Risk Pool Financial Analyst in preparation and delivery of financial, clinical, and business analysis. This includes the accurate quantification and measurement of clinical outcomes. In addition, other key...

  • Financial Auditor

    2 days ago


    Los Angeles, United States augmentjobs Full time

    Job DescriptionJob DescriptionJob Description: Financial AuditorOverview: As a Financial Auditor, you will play a critical role in evaluating and ensuring the accuracy, integrity, and compliance of financial operations within the organization. Your responsibilities will include examining financial records, conducting audits, identifying areas of risk or...

  • Senior Auditor

    2 months ago


    Los Angeles, United States Sterling Freeman Full time

    Senior Auditor – Woodland Hills, CA CPA Firm Job Our Los Angeles area clients bring the most interesting and challenging opportunities with International, pre-IPO preparation, and ultra and high net-worth client complexities. They are leaders in industries such as technology, biotechnology, manufacturing, or health care. With us, you'll find all the...

  • Senior Auditor

    3 weeks ago


    Los Angeles, United States Sterling Freeman Full time

    Senior Auditor – Woodland Hills, CA CPA Firm Job Our Los Angeles area clients bring the most interesting and challenging opportunities with International, pre-IPO preparation, and ultra and high net-worth client complexities. They are leaders in industries such as technology, biotechnology, manufacturing, or health care. With us, you'll find all the...

  • Internal Auditor

    1 week ago


    Los Angeles, United States Consultative Search Group Full time

    Job DescriptionJob DescriptionA fast-growing medical device company, located in the Glendale/Los Angeles area seeks an Internal Auditor to join their dynamic team. You will have the opportunity to partner with a dynamic business operations team, contributing your financial insights to enhance internal control processes and improve daily operations. This role...

  • Internal Auditor

    6 days ago


    Los Angeles, United States Consultative Search Group Full time

    Job DescriptionJob DescriptionA fast-growing medical device company, located in the Glendale/Los Angeles area seeks an Internal Auditor to join their dynamic team. You will have the opportunity to partner with a dynamic business operations team, contributing your financial insights to enhance internal control processes and improve daily operations. This role...

  • Internal Auditor

    7 days ago


    Los Angeles, United States Consultative Search Group Full time

    A fast-growing medical device company, located in the Glendale/Los Angeles area seeks an Internal Auditor to join their dynamic team. You will have the opportunity to partner with a dynamic business operations team, contributing your financial insights to enhance internal control processes and improve daily operations.This role is starting out on a Temporary...

  • Internal Auditor

    4 days ago


    Los Angeles, United States Consultative Search Group Full time

    A fast-growing medical device company, located in the Glendale/Los Angeles area seeks an Internal Auditor to join their dynamic team. You will have the opportunity to partner with a dynamic business operations team, contributing your financial insights to enhance internal control processes and improve daily operations.This role is starting out on a Temporary...

  • Internal Auditor III

    3 weeks ago


    Los Angeles, United States Veracity Software Inc Full time

    Internal Auditor III (Remote/Hybrid) Remote | Hybrid We are currently all mainly remote. Candidate must live in California at time of hire and open to coming into our Downtown LA office once a quarter. Los Angeles, CA The Internal Auditor III prepares audit programs and conducts audit reviews of assigned areas, including performing various audit...

  • Internal Auditor III

    3 weeks ago


    Los Angeles, United States Veracity Software Inc Full time

    Internal Auditor III (Remote/Hybrid) Remote | Hybrid We are currently all mainly remote. Candidate must live in California at time of hire and open to coming into our Downtown LA office once a quarter. Los Angeles, CA The Internal Auditor III prepares audit programs and conducts audit reviews of assigned areas, including performing various audit procedures...

  • HCC Auditor

    4 weeks ago


    Los Angeles, United States Century Group Full time

    Century Group is partnering with a client who is seeking a HCC Auditor to join their team. The HCC Risk Adjustment/Auditor will be responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. Exact compensation may vary based on skills, experience, and location. Expected starting base salary $25 to $26 per...

  • Internal Auditor III

    1 month ago


    Los Angeles, United States Veracity Software Inc Full time

    Internal Auditor III (Remote/Hybrid) Remote | Hybrid We are currently all mainly remote. Candidate must live in California at time of hire and open to coming into our Downtown LA office once a quarter. Los Angeles, CA The Internal Auditor III prepares audit programs and conducts audit reviews of assigned areas, including performing...


  • Los Angeles, United States City National Bank Full time

    Overview: **MANAGER OF AUDIT II- RISK MANAGEMENT** **WHAT IS THE OPPORTUNITY?** The Audit Manager II position is a leadership role as an auditor-in-charge to guide a team of auditors to assess risks, develop detailed audit programs, identify data analytic opportunities, execute audit programs, analyze results of testing performed, and effectively...

  • Internal Auditor

    4 weeks ago


    Los Angeles, United States Guess Full time

    Job Description POSITION TITLE: Internal Auditor POSITION PURPOSE: Perform complex level professional internal auditing work involving performance, financial and compliance audit projects. Work independently or in a team under general supervision by Senior Audit staff. ESSENTIAL FUNCTIONS: Partners and assist Senior Auditor staff to evaluate the...

  • Internal Auditor

    4 days ago


    Los Angeles, United States Guess Full time

    Job Description POSITION TITLE: Internal Auditor POSITION PURPOSE: Perform complex level professional internal auditing work involving performance, financial and compliance audit projects. Work independently or in a team under general supervision by Senior Audit staff. ESSENTIAL FUNCTIONS: Partners and assist Senior Auditor staff to evaluate the...

  • Internal Auditor

    3 weeks ago


    Los Angeles, United States Guess Full time

    Job Description POSITION TITLE: Internal Auditor POSITION PURPOSE: Perform complex level professional internal auditing work involving performance, financial and compliance audit projects. Work independently or in a team under general supervision by Senior Audit staff. ESSENTIAL FUNCTIONS: Partners and assist Senior Auditor staff to evaluate the...


  • Los Angeles, United States Consultative Search Group Full time

    Our client is a well-established, publicly-traded asset management firm with corporate headquarters in Los Angeles. They are seeking a Senior Internal Auditor to join their dynamic team. The Senior Auditor position will be responsible for conducting operational, financial, and regulatory internal audits (no SOX testing). The following statements are intended...