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THE POSITION.
This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible for management and monitoring of claims compliance with all products and lines of business for managed care claims payments. This person is the liaison with internal clients to resolve claim processing issues. Responsible to train claims examiners and is a resource relating to claims guidelines.
THE SPECS.
THE DUTIES.
*Please note that the duties and responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.
THE COMPANY.
Innovative Management Systems is a management services company focused on finding innovative ways to ensure regulatory compliance, customer services, provider experience, and measurable outcomes in the healthcare industry. Through our ever-evolving data analytics platform, we strive to improve overall medical spending, HEDIS, and STAR measures through a collaborative effort of education, reporting and workflow management. Come be part of the team that helps to improve quality of care, reduce administrative burden, and achieve greatness through creative thinking and educated calculated risks. Be the change in healthcare everyone talks about, but few people achieve. We value our team's opinions and new ways of getting the job done and are looking for self-starters with fresh ideas, ready to help pave the way to a better tomorrow.
We are an Equal Opportunity Employer and seek diversity in our workforce. We are also an E-Verify Employer , you can learn more about E-Verify program and your rights and responsibilities here: Learn More About E-Verify.
Requirements:EDUCATION.
EXPERIENCE.
SKILLS, KNOWLEDGE, ABILITIES, OTHER CHARACTERISTICS
Compensation details: 33-40 Hourly Wage
PI5551cba2454d-31181-27963395
Full Time
$52k-65k (estimate)
05/01/2024
05/20/2024
imsmso.com
Los Angeles, CA
The following is the career advancement route for Claims Auditor positions, which can be used as a reference in future career path planning. As a Claims Auditor, it can be promoted into senior positions as a Claims Quality Auditor III that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Claims Auditor. You can explore the career advancement for a Claims Auditor below and select your interested title to get hiring information.