Medical Claims Auditor

Location: North Hollywood, California
Date Posted: 11-28-2017


 Job Description & Responsibilities: 

•Position audits medical claims that have been processed by various insurance companies for multiple clients.
•Successful candidates must have experience processing or auditing, claims for insurance carriers, third party administrators or self- insured plans.
•Audit indemnity medical claims to ensure they are processed in accordance with provider contracts and member benefits
•Complete audit reports within assigned budgets and deadlines
•Some travel required (between 6-12 weeks per year)

Knowledge, Skills & Qualifications:
•Knowledge of ICD-9/ICD-10, CPT Coding, Revenue Codes, HCPCS, CMS-1500, UB-04
•Excellent evaluation and reconciliation skills
•Excellent verbal and written communication skills
•Minimum five (5) years processing Indemnity medical claims
•Must have experience and good understanding of COB rules  and Medicare regulatory guidelines
•Ability to comprehend and interpret PPO provider Contracts, Summary Plan Description (SPD), and Employee Summary of Benefit documents.
•Ability to function calmly in a fast paced environment handling multiple priorities.
•Flexible in light of changing situations and circumstances
•Basic Knowledge of Health Care Reform
•Proficiency in use of various Microsoft software such as, Windows, Excel, Word and Outlook
 
 
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