What are the responsibilities and job description for the Claims Auditing Specialist position at Unified Group Services?
Unified Group Services is a full-service third party administrator (TPA) for self-insured group health plans. We're dedicated to providing excellent customer service and the flexibility our customers desire in administering employee benefit plans.
Unified Group Services has a reputation for excellent customer service in the marketplace, and this position is crucial to continuing that status.
The Auditing Specialist is responsible for auditing claims for payment accuracy such as date of service, provider of service, diagnostic & procedure codes, modifiers, account number, coverage codes, and plan benefit type that are over a Claims Account Manager's check max to include spot checks. It also involves releasing and or resetting claims before the billing day. Due to the daily feedback of audit returns to the claims processor, this person must work inside our office. Auditors may also be called on to audit claim charges over $10,000 since they require a review by two auditors. This job requires basic knowledge of our PPOs, fee schedule maintenance, group maintenance, provider maintenance, and provider lists.
Job Qualifications
High School Diploma or GED. Some college helpful but not required
Working knowledge of Microsoft Word, Excel, and Outlook is required
Strong math skills.
Attention to detail and the ability to meet deadlines are critical to success.
Professional phone communication skills.
Good organizational skills and excellent customer service.
Good writing skills, using proper grammar, punctuation, and sentence structure.
Self-motivated & self-starter with a willingness to learn.
Excellent attendance.
Hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.
Unified Group Services has a reputation for excellent customer service in the marketplace, and this position is crucial to continuing that status.
The Auditing Specialist is responsible for auditing claims for payment accuracy such as date of service, provider of service, diagnostic & procedure codes, modifiers, account number, coverage codes, and plan benefit type that are over a Claims Account Manager's check max to include spot checks. It also involves releasing and or resetting claims before the billing day. Due to the daily feedback of audit returns to the claims processor, this person must work inside our office. Auditors may also be called on to audit claim charges over $10,000 since they require a review by two auditors. This job requires basic knowledge of our PPOs, fee schedule maintenance, group maintenance, provider maintenance, and provider lists.
Job Qualifications
High School Diploma or GED. Some college helpful but not required
Working knowledge of Microsoft Word, Excel, and Outlook is required
Strong math skills.
Attention to detail and the ability to meet deadlines are critical to success.
Professional phone communication skills.
Good organizational skills and excellent customer service.
Good writing skills, using proper grammar, punctuation, and sentence structure.
Self-motivated & self-starter with a willingness to learn.
Excellent attendance.
Hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.