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Health Claims Audit Manager
3 months ago
Looking to work at a firm with an unbeatable culture?
Withum is a forward-thinking, technology-driven advisory and accounting firm, helping clients to Be in a Position of StrengthSM in today’s modern business landscape. Withum empowers clients with innovative tools and solutions to address their accounting, tax and overall business management needs. Withum is a place where talent thrives. We recruit only the best and brightest people, with a genuine passion for the business.
Withum is seeking an experienced health claims auditor possessing in-depth knowledge of group health and disability claims procedures, medical/dental terminology, including CPT, ADA, HCPC and ICDA codes, and a thorough understanding of automated health claims systems as well as manual claims payment systems.
How You’ll Spend Your Time:
Working closely with our clients to ensure that health, dental, prescription and vision claims are being paid in compliance with regulations and plan documents Reviewing client's claims adjudication internal controls policies and procedures Completing audit workpapers documenting procedures, findings and conclusions within assigned budgets and deadlines Responsible for scheduling and oversight of claims team (3-5 at any given time) Review work of team members and present to engagement partner for their final reviewThe Type's of People We Look For Have the Following Qualities:
BS Degree Must be qualified at analyzing and interpreting group health insurance contract provisions and reviewing administrative policies and PPO contracts Experience supervising staff and working within a team environment Must be familiar with HIPAA and ACA compliance standards Must have a minimum of 7-10 years of health claims processing experience (internal auditing skills a plus) Good computer skills (Microsoft office preferred), excellent communication skills Ability to travel 2-4 years of managerial experience in health claims processing is a plus