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Desert Oasis Healthcare is Hiring a Claims Auditor Near Palm Desert, CA
- Audit completed claims for all products / Ensure daily self-audit report are performed by the claims team.
- Perform all daily self-audit reports.
- Audits randomly selected claims to ensure quality processing.
- Follows adjudication policies and procedures to ensure proper payment of claims.
- Follows the eligibility research protocol including verifying member benefits and COB.
- Review authorization status codes and notes affecting the adjudication of the claim.
- Submit claims inquiry to UM per protocol.
- Perform audits of claims involving high dollar and network specialty pools.
- Apply provider contract rates appropriately based on effective dates and amendment updates.
- Meet productivity and error ratio standard as required.
- Reconcile Health Plan error reports as required.
- Adjudicate professional, facility and high dollar claims in accordance with Managed Care Operations, CMS and AZPC Guidelines.
- Researches reports from various data sources for management.
- Analyzes audit results for trends and root cause issues.
- Maintains/track production and quality scores for each employee.
- Creates and maintains auditing policies and procedures.
- Conduct periodic post audit of claims to alleviate any incorrect decisions
- Communication with management on audit findings, assist with error validation process
- Utilizes the plan documents in order to properly adjudicate claims and answer questions regarding claims. Fee schedules and Medicare regulations are provided for determining proper payment.
- Research and resolve, working with Claim team, customer service issues in a timely manner to ensure quality claims service.
- Assist claims management in training of team regarding contract application and disseminating info regarding adjudication policies and procedures.
- Perform other duties as assigned.
- High school diploma or equivalent required.
- Minimum 5 years recent claims and/or billing experience.
- Claims auditing experience desired.
- Knowledge of medicine and medical terminology, CPT, HCPCS, ICD.9, and DSM codes
- Must have experience with UB92 forms
- Familiar with all regulatory requirements including CMS and DHS
- Must be able to work under general guidance of Claims Lead with little direct supervision
- Must be meticulous and pay attention to detail.
- EZ-Cap experience is a plus
- Strong data entry skills (10,000 keys strokes alpha/numerical)
- Must be able to work independently and exercise judgment
- Must be able to work on computer systems, accessing multiple files
- At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.
Job Summary
Full Time
Ambulatory Healthcare Services
$53k-67k (estimate)
05/12/2024
07/10/2024
mydohc.com
INDIO, CA
200 - 500
1981
RANDY VAUGHN
$10M - $50M
Ambulatory Healthcare Services
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About Desert Oasis Healthcare
Desert Oasis Healthcare is committed to the provision and facilitation of the highest quality medical care to the residents of the desert communities. We will strive to be an organization which provides excellence in every encounter. As a result, we will be recognized by: Our patients as their care givers of choice; Our employees as their employer of choice; Our provider and health plan partners as their health care network of choice. Desert Oasis Healthcare is a non-discriminate (Religious, Cultural, Sexual, Ethnic) Health Care Provider. In 1981, Desert Medical Group Inc. introduced to the Co ...
achella Valley a full service medical facility, providing the community with all their health care needs from newborn to senior care. Today, we are Desert Oasis Healthcare - a team of highly skilled primary care physicians and ancillary providers with services conveniently located throughout the desert communities. Our many locations include Palm Springs, Bermuda Dunes, Indio, Rancho Mirage and Yucca Valley. Desert Oasis Healthcare's services include access to 4 Immediate Care Centers - Indio, Palm Desert, Palm Springs and Yucca Valley. We also offer an award winning Outreach Services Department that is committed to educating individuals on how to apply the principles of preventative health care in their daily lives, resulting in improved health. Desert Oasis Healthcare accepts most HMO's, private insurance, Medicare and private pay patients. We are affiliated with every hospital in the Coachella Valley, which includes Eisenhower Memorial Hospital, Desert Regional Medical Center, John F. Kennedy Memorial Hospital and Hi-Desert Medical Center
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The job skills required for Claims Auditor include Auditing, Health Insurance, Customer Service, Claim Processing, Billing, 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.
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