Claims Appeal Auditor
6 days ago
Century Group is partnering with a client who is seeking a Claims Appeal Auditor. Exact compensation may vary based on skills, experience, and location. Expected starting base salary $22.50 to $24.50 per hour.
Essential Duties and Responsibilities include the following:
- Provide reports and on-going updates to Claims management
- Assist in the processing of appeals (reconsiderations), special projects and reconciliations from all sources
- Oversee staff activities to maintain high level of productivity
- Monitor appeals related functions to ensure health plan and regulatory compliance.
- High School Diploma and 3 years adjudication experience in a managed care setting
- Knowledge of CPT-4, HCPCS, Hospital Revenue, and ICD-9 coding
- Knowledge of HMO, DHS, DMHC, and CMS claims processing guidelines
- Strong knowledge of Microsoft Word and Excel
- Strong knowledge of Coordination of Benefits (COB) applications
- Ability to communicate effectively orally and written typing 35 words per minute
- Strong organizational skills with emphasis on prioritizing and attention to details
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