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Senior Claims Audit Manager

2 months ago

Anaheim, United States Providence Health & Service Full time
Position Overview:
As a Senior Claims Audit Manager, you will oversee the internal audit functions related to claims processing, ensuring the integrity and accuracy of adjudicated claims and encounters.

Your role will involve monitoring the check run process to guarantee precision and compliance.

Key Responsibilities:
  • Develop and implement policies and procedures for regular claims audits, ensuring adherence to standards set by affiliated health plans and contractual agreements.
  • Design and facilitate comprehensive training programs for claims processing staff, adapting to evolving policies, procedures, and technologies.

At Providence Health & Services, we value our caregivers as essential contributors to our mission. Your insights and contributions are vital to fostering a culture of patient-centered care, built on respect and collaboration.

Qualifications:
To be considered for this role, you should possess:
  • A Bachelor's Degree or equivalent experience.
  • A minimum of 10 years of experience in HMO claims processing and/or auditing within a managed care environment, ideally in a PMG/IPA setting.

Why Choose Providence?
We offer a competitive benefits package designed to support your well-being and professional growth. Our commitment to caring for our communities drives our mission, and we strive to create an inclusive workplace where diversity is celebrated.

About Providence:
Providence is dedicated to delivering high-quality, compassionate care across various states. Our extensive network includes numerous hospitals, clinics, and health services, all aimed at serving the needs of our communities.

Join us in our commitment to excellence in healthcare and be part of a team that values every individual.