Audit of claims to alleviate any incorrect decisions
Maintain a record of audit results
Submit errors back to the proper source
Review, research, and resolve complex claims processing issues
Other duties and special projects as specified by the Director/​Supervisor
Requirements
At Least 5+ Years Experience examining claims with 5+ years of Managed Care HMO experience
Experience with HMO, Managed Care, Medicare, Medi-Cal, Commercial, Senior, DRG/RCC rates, ICD-9, anesthesia claims, in-patient claims, SNF, DME, dialysis, chemo, stop loss or case rates, COB, outpatient surgeries, ER and all other claim types