Claims Auditor
American Health Partners
full-time
Posted on:
Location Type: Hybrid
Location: Franklin • Oklahoma, Tennessee • 🇺🇸 United States
Visit company websiteJob Level
JuniorMid-Level
About the role
- Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
- Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
- Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
- Work assigned claim projects to completion
- Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
- Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
- Maintain production and quality standards as established by management
- Participate in and support ad-hoc audits as needed
- Other duties as assigned
Requirements
- Proficient in processing/auditing claims for Medicare and Medicaid plans
- Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
- Current experience with both Institutional and Professional claim payments
- Knowledge of automated claims processing systems
- Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
- Two (2) years’ experience in managed healthcare environment related to claims processing/audit
- Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
- Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
- Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
- Coding certification preferred
Benefits
- Affordable Medical/Dental/Vision insurance options
- Generous paid time-off program and paid holidays for full time staff
- TeleMedicine 24/7/365 access to doctors
- Optional short- and long-term disability plans
- Employee Assistance Plan (EAP)
- 401K retirement accounts
- Employee Referral Bonus Program
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingclaims auditingMedicare claimsMedicaid claimsautomated claims processing systemsCPT4ICD10HCPCScomplex claims processingstandard coding
Soft skills
customer servicequality assuranceproblem solvingattention to detailcommunicationorganizational skillsteam collaborationescalation managementtime managementadaptability
Certifications
coding certification