Healthcare Claims Auditor

2 months ago


Los Angeles, California, United States MedPOINT Management Full time
Job Summary

MedPOINT Management is seeking a skilled Healthcare Claims Auditor to join our team. As a key member of our Claims Department, you will be responsible for ensuring the accuracy and compliance of claims processes.

Key Responsibilities
  • Audit daily processed claims through random selection, utilizing system-generated reports to identify trends and issues.
  • Conduct Claims Examiner training and document training materials and attendees.
  • Research and analyze contract issues, system-related problems, and claims processing policies to recommend actions to Senior Management.
  • Collaborate with other departments to ensure seamless claims processing.
  • Develop and maintain Claims Department policies and procedures.
  • Provide backup support for other auditors and trainers within the department.
  • Perform other tasks as assigned by Senior Management.
Requirements
  • High School Diploma required.
  • Three years of experience in a managed care claims adjudication setting, such as HMO/MSO.
  • Expertise in coding structure, ICD-10, CPT-4, and Revenue Codes.
  • Strong understanding of provider and health plan contracting, risk delineation, medical terminology, and standard industry reimbursement methodologies.
Preferred Qualifications
  • Strong organizational, analytical, and communication skills.
  • Proficiency in PC application skills, such as word processing and spreadsheets.
  • Experience in training development and presentation.


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