Claims Auditor NEEDED ASAP
Company: TEKsystems
Location: Northridge
Posted on: April 25, 2024
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Job Description:
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
requirements for claims processing, payment and procedural
accuracy. In addition, this position is responsible to assist with
eligibility identify (e.g. COB, ESRD) and Letters of Agreements as
required. To maintain in strict confidence, all member, provider
and Health Plan information to which Claims Auditing Specialist has
access.
Skills:
ez cap, claims examiner, claims coordinator hippa, hmo, ppo
Top Skills Details:
ez cap, claims examiner, claims coordinator hippa, hmo, ppo
Additional Skills & Qualifications:
1. Performs routine and complex audits on individual, random,
trainee and focused claims to identify exceptions to established
claims adjudication requirements for both Pre-EOB and post
payment.
2. Perform 1st level audit based on reports and run Virtual
Examiner Reports prior to each check run.
3. Researches claim processing problems and errors to determine
their origin and appropriate resolution.
4. Researches member activity to identify Coordination of Benefits,
Third Party Liability, Out-of-Area and Workers' Compensation as
identified through member admissions, authorization process or
claims activity
5. Notify management immediately if any report processing deadlines
cannot be met.
6. Identify, proactively through auditing and internal reporting,
negative and positive trends and initiate recommendations for
change
7. Analyze data processing reports and make necessary corrections
or adjustments
8. Assist with training of claims adjudication staff as needed
9. Assist manager with follow-up on any problems or questions
related to the audit results
10. Other duties as assigned
Experience Level:
Entry Level
About TEKsystems:
We're partners in transformation. We help clients activate ideas
and solutions to take advantage of a new world of opportunity. We
are a team of 80,000 strong, working with over 6,000 clients,
including 80% of the Fortune 500, across North America, Europe and
Asia. As an industry leader in Full-Stack Technology Services,
Talent Services, and real-world application, we work with
progressive leaders to drive change. That's the power of true
partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all
applications without regards to race, sex, age, color, religion,
national origin, veteran status, disability, sexual orientation,
gender identity, genetic information or any characteristic
protected by law.
Keywords: TEKsystems, Compton , Claims Auditor NEEDED ASAP, Accounting, Auditing , Northridge, California
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