What are the responsibilities and job description for the Claims Quality Auditor position at UCLA Health System?
Description
Take on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health.
The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor. You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures. You will:
Research over and under-payment inquiries/appeals
Compile and maintain statistical data consistent
Maintain departmental production and quality standards
Salary Range: $31.51 - $62.64 Hourly
Qualifications
We’re seeking a self-motivated, detail-oriented, deadline-driven individual with:
High school diploma, GED or equivalent
Four or more years of medical claims payment experience in an HMO environment
Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS
Understanding of Medicare Guidelines and COB
Knowledge of medical terminology
Experience in benefit determination and claims adjudication
Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM
Understanding of professional and facility reimbursement methodologies
Strong organizational skills
Computer proficiency with Microsoft Office
Knowledge of claims adjudication systems
Flexibility and adaptability $31.51-62.64 Hourly Monday - Friday, 8:00am - 4:30pm PST
Salary : $32 - $63