Auditor – Provider Recovery
IEHP
full-time
Posted on:
Location Type: Hybrid
Location: Rancho Cucamonga • California • United States
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Salary
💰 $63,897 - $83,075 per year
About the role
- Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
- Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
- Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.
- Promote teamwork and maintain effective working relationships with others throughout the organization.
- Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
Requirements
- Minimum of four (4) years of claims processing experience including Medicare and Medi-Cal
- Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
- Experience with MS Office applications
- High School Diploma or GED required
- Bachelor’s degree from an accredited institution preferred
- Knowledge of Medi-Cal and CMS guidelines for claim payments
- Strong analytical and problem-solving skills
- Proficient in Microsoft Office, including being able to manipulate large data sets in Excel files
- Excellent oral and written communication skills
- Ability to build successful relationships across the organization
Benefits
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Competitive salary
- State of the art fitness center on-site
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingauditing claimsfinancial DOFR interpretationdata manipulationExcel
Soft Skills
analytical skillsproblem-solving skillsoral communicationwritten communicationrelationship buildingteamwork
Certifications
High School DiplomaGEDBachelor’s degree