What are the responsibilities and job description for the Healthcare Claims Auditor /Medical Claims position at swipejobs?
Job Description:
The Claims Auditor assists in the Claims Department by analyzing procedures, policies and reports; ensures appropriate payment of claims and maintenance of the claims system as necessary.
COMMUNICATION
Talking or hearing essential to communicate with patients and staff.
Good communication skills; read, speaks and writes English fluently.
Bilingual Skills In Spanish/Chinese Preferred
SPECIFIC SKILLS NEEDED:
Knowledge of HMO/or IPA operations; medical terminology; ICD-10, RVS, and CPT coding knowledge; knowledge of Medicare and Medi-Cal guidelines; 10-key skills by touch; excellent communication skills; knowledge of system applications; ability to function effectively under time deadlines; strong organizational skills.
EDUCATION REQUIRED:
High school diploma or equivalent; four years medical claims processing.
Duties And Responsibilities
Prof23
#Prof23
The Claims Auditor assists in the Claims Department by analyzing procedures, policies and reports; ensures appropriate payment of claims and maintenance of the claims system as necessary.
COMMUNICATION
Talking or hearing essential to communicate with patients and staff.
Good communication skills; read, speaks and writes English fluently.
Bilingual Skills In Spanish/Chinese Preferred
SPECIFIC SKILLS NEEDED:
Knowledge of HMO/or IPA operations; medical terminology; ICD-10, RVS, and CPT coding knowledge; knowledge of Medicare and Medi-Cal guidelines; 10-key skills by touch; excellent communication skills; knowledge of system applications; ability to function effectively under time deadlines; strong organizational skills.
EDUCATION REQUIRED:
High school diploma or equivalent; four years medical claims processing.
Duties And Responsibilities
- Safeguards and preserves the confidentiality of patient's protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital and departmental policies.
- Ensures a safe patient environment and adherence to safety practices per policy.
- With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant other when administering care.
- Assist the Claims Director in the training and education of the Claims department staff
- Coordinate the generation and review of claims audit, status and pending claims reports ensuring authorized claims are paid in accordance with company guidelines
- Investigate, process and track payment adjustments including refunds, overpayments and underpayments
- Act as a confidential and professional resource for group providers and other staff.
- Act as a resource for providers, members, insurance carriers, attorneys and co-workers, researching and responding to questions in a timely manner
- Create, maintain and generate system reports
- Interface with the Claims Director to ensure claims processing functions meet legal and contractual requirements with regards to health plan audits
- Prepare and present weekly and monthly reports reflecting staff and departmental quality statistics
- Review and audit member liability denials and Provider Dispute Resolution claims to ensure compliance with regulatory requirements and passing audit scores from health plans
- Perform other duties as assigned
Prof23
#Prof23
Salary : $28