Remote Internal Claims Auditor
Remote Internal Claims Auditor
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Job Description
WHAT YOULL BE DOING
- Understand and stay current with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations.
- Ensure accuracy of claims processing and contract logic builds through internal audit processes.
- Perform targeted audits of claims processing including but not limited to high dollar payments benefit matrix interest payments prepayment and postpayment audits and multiple procedure claims.
- Perform quality audits of claims staff eligibility staff and system logic.
- Perform audits of new client setup in the claims processing software.
- Run access queries as needed for administrative purposes.
- Other duties and responsibilities as assigned.
Qualifications :
WHAT YOULL NEED TO HAVE
- Minimum 3 years of experience in the healthcare or managed care industry including claims/reimbursement experience professional analyticsrelated experience and experience working on/managing major projects
- 13 years auditing experience in the healthcare industry
- Advanced to expert proficiency in the Microsoft Office products especially Microsoft Word Microsoft Excel & Microsoft Access
- Able to problem solve exercise initiative and make low to medium level decisions
- Thorough understanding of current federal state and local healthcare compliance requirements
- Ability to meet deadlines and prioritize tasks; collect correlate and analyze data
- Ability to work independently with minimal supervision and as part of a team
- Must be organized selfmotivated detailoriented disciplined professional and a team player
- Effective written and oral communication
WOULD LOVE FOR YOU HAVE
- Bachelors degree in healthcare informatics business administration or related field or equivalent in experience and education
- Certified Professional Coder strongly recommended
- Prior claims processing experience within Eldorado HealthPac Claims Adjudication System is a plus
- Claim coding experience coding edits experience and APC Pricing knowledge
- CPT and ICD coding knowledge
Additional Information :
The base pay range for this role is between $19.00 to $21.91 per hour paid biweekly
All your information will be kept confidential according to EEO guidelines.
COMPENSATION:
The listed compensation range listed is paid biweekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.
OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT
Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment.
OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA
This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties. For any securityspecific roles the responsibilities would be further defined by the hiring manager.
REMOTE WORK TECHNICAL REQUIREMENTS
Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.
Remote Work :
Yes
Employment Type :
Fulltime
Employment Type
Remote
