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Medical Claims Auditor

4 months ago

Newtown Square, United States Midatlantic Employers' Association Full time
Job DescriptionJob Description

Medical Claims Auditor / Trainer

(Health Insurance)

(CPT, ICD-10)

Newtown Square, PA

(Full Time, Permanent Role)

We are an established employer in Newtown Square, Delaware County, Pennsylvania, and are seeking a full-time Claims Auditor - Trainer to join our team.

This Non-Exempt position consists of a 37.50-hour work week with daily work hours of: 8:30am to 5:00pm, Monday through Friday.

About the role:

This position is responsible for auditing the Health Plan claims for accuracy including manually-processed claims as well as any claims that were adjudicated electronically via BlueCross, Guardian, Medicare Crossover and SDS.

The position is also responsible for any "in-house training" for all new claims employees or of existing claims personnel on any changes.

Key Responsibilities Include:

· Responsible for auditing claims for accuracy and maintaining a 99.55% accuracy rating on all audited claims,

· Responsible for identifying errors and making the proper adjustments as needed,

· Responsible for finalizing claims in BlueCross CADF and GUI systems,

· Responsible for all in-house training of all new claims examiners or member service representatives on the company health plan benefits, procedures, and the claim payment systems,

· Responsible for training all existing claims personnel on plan benefit and system changes,

· Responsible for completion and accurate release of claims that require adjustments,

E.O.E./M/F/H/V



About You:

· Minimum of two (2+) years of college and/or completion of insurance courses preferred,

· Minimum of (2+) years of hands-on experience processing online medical claims and/or related computer experience required,

· Previous teaching/training experience preferred,

· Previous knowledge of a health benefit plan and claims adjudication system preferred,

· Previous computer experience (Microsoft Office Suite or related) required,

· Must be reliable and have acceptable and predicable attendance,

· Excellent interpersonal skills and communication skills,

· Strong analytical skills,

· Must be detail oriented,

· Proficient computer skills with the ability to learn new software,

· Knowledge of Current Procedure Terminology (CPT) and ICD codes,

· Knowledge of preferred provider Organization (PPO) network experience preferred,



Benefits:

We offer a Competitive salary, with excellent "employer-paid" benefits such as:

401k

Defined Benefit Plan

Generous PTO

Holiday pay

Pleasant working environment.