Medical Claims Auditor

Location: North Hollywood, California
Date Posted: 06-27-2018
Medical Claims Auditor
 
Miller Kaplan Arase LLP is a CPA firm committed to excellence in work product and client service.   We specialize in Entertainment, Licensing and Royalties, Media, Employee Benefit Plans, Labor Organizations and Nonprofit Organizations.

Responsibilities/Duties:
  • Conducts post payment claims audits on adjudicated medical, dental, and vision claims processed by various insurance companies, third party administrators, and self-insured plans for multiple clients.
  • Conducts detail audits to ensure claims are processed in accordance with Hospital/Provider contracts, member plan benefits, compliance, and company policies and procedures.
  • Conducts analysis review of claims data and reconciliation data required for preparation of claims audits.
  • Reviews and analyzes error trends in processing.
  • Research, document, and report audit error findings to clients.
  • Provides analysis and prepares recommendations to Management for errors and inconsistences.
  • Provides a detailed summarized analysis report to report audit errors identified.
  • Provides process improvement suggestions to Management.  
  • Manages multiple projects to make sure deadlines are met within assigned budgets.
  • Performs other related duties as assigned or required.

Knowledge/Skills/Qualifications:
  • Excellent communication skills (written and verbal).
  • Customer service oriented.
  • Strong data analysis proficiency using a variety of software packages.
  • Strong quantitative and analytic skills.
  • Strong problem-solving skills.
  • Excellent organization skills
  • Ability to schedule, track and perform multiple tasks, meet deadlines and adapt to fast-paced environment.
  • Ability to work independently and as part of a team.
  • Some travel required to client work sites within the greater L.A. area. (between 6 to 12 weeks per year). – Requires traveling to work sites daily within the Greater L.A area. Some travel required outside of L.A. area is also required. (between 6-12 weeks per year).   
  • Minimal 5 years of experience in medical claims processing and/or auditing.
  • Knowledge of CPT, ICD-10, HCPCS codes and medical terminology.
  • Knowledge of Coordination of Benefit rules, including Medicare regulations and PPO contracts.
  • Basic knowledge of Health Care Reform
  • Ability to comprehend and interpret PPO contracts, Summary Plan Description(SPD), and Employee Summary of Benefit materials.
 
Education:
  • High school diploma
 
Since 1941 Miller Kaplan Arase LLP has provided the highest quality of accounting and consulting services, with offices in Los Angeles, San Francisco, Seattle, Las Vegas, Denver and Sun Valley, Idaho. We are ranked among the 10 largest Los Angeles-headquartered accounting firms and are one of the top 100 public accounting firms in the United States. At Miller Kaplan Arase LLP we are committed to our employees reaching their highest potential while building a fulfilling career. We provide quality training, a lifetime learning experience and a positive work environment. The firm offers competitive salary with full benefits including medical, dental, vision, 401(k) profit sharing, LTD, FSA, paid holidays, vacation and sick days.
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