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SUMMARY: Responsible for auditing and training claims staff on all Managed Care claims received from outside providers to ensure the Claims Examiners processed and adjudicated them accurately and consistently in accordance with outside Provider Contracts, State, Federal, CMS, DMHC and Health Plan contracts, internal departmental policies and procedures. Must maintain a productivity standard of auditing 15 claims per hour.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Some knowledge of Microsoft Word, Excel and Access database software programs is required.
EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED); or Four (4) or more years with claims processing experience and/or training; or equivalent combination of education and experience. Must possess a strong knowledge of the Centers for Medicare and Medicaid Services (CMS), the Department of Managed Health Care (DMHC) and HMO standards and requirements.
Full Time
08/27/2022
12/12/2022
uhsofdelaware.com
Upper Merion Township, PA
<25
The job skills required for CLAIMS AUDITOR include Auditing, Claim Processing, etc. Having related job skills and expertise will give you an advantage when applying to be a CLAIMS AUDITOR. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by CLAIMS AUDITOR. Select any job title you are interested in and start to search job requirements.
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.