Description. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHS. This position includes the responsibility for routine hospital and professional audits, complex audits on individual or random, training and focused claims to identify exceptions to established claims adjudication req...
The primary role of the Claims Analyst is to review. identify. and. validate. claim overpayments. Types of overpayment reviews will include, but are not limited to, Duplicate Payment, Contract Compliance, Authorizations, Eligibility, Coordination of Benefits, Medical Review, and. Medicare. and Medicaid reimbursement policies. . You may be ideal if you have. Experience with payer/provider contracting and claims processing protocols. Working knowle...
Apply. Job Type. Full-time. Description. With general supervision, verify claims processing, system accuracy, and data entry accuracy, identify and communicate errors, and track errors for trends.Essential Functions Perform scheduled quality assurance audits for both In-Network and Out-of-Network claimsRecord and track audit errors. identify trends and opportunities to improve qualityProvide feedback from errors and submit quality assurance audit...
POSITION SUMMARY/RESPONSIBILITIES. Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowled...
POSITION SUMMARY/RESPONSIBILITIES. Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowled...
Position Summary. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHS. This position includes the responsibility for routine hospital and professional audits, complex audits on individual or random, training and focused claims to identify exceptions to established claims adjudicatio...
Role: Claims Auditor. Location: Remote. Term: Long Term Contract. Associate should have 2 years of experience with Claims Adjudication. Should have the knowledge in manual pricing with the following types of claims. Medicare inpatient hospital claims, outpatient hospital, ancillary and professional claims. Good knowledge in DOFR claims. Knowledge in EZ Cap, Optum Webstrat & Burgess pricing application is preferrable. Should possess good communica...
Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career.JOB SUMMARY. . Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and...
Description. 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...
