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Auditor (Analyst) - Medical Cl...

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Job Summary

Location
Woodland Hills, CA
Industries
Insurance
Healthcare Services
Job Type
Full Time
Employee
Years of Experience
2+ to 5 Years
Career Level
Experienced (Non-Manager)

Auditor (Analyst) - Medical Claims

About the Job

  1. Audits claims to identify examiner and system errors. Research and resolve.
  2. Maintains a solid working knowledge of Health plan and provider contracts, division of responsibility (DOFR), and CPT/ICD9 coding.
  3. Audits daily professional and facility claims
  4. Flags claims for examiner errors.
  5. Researches system configuration against contracts and flag claims for system configuration errors.
  6. Calculates drug claims
  7. Audits and tests system configuration changes or new client implementations
  8. Reviews daily audit reports and takes appropriate actions.
  9. Performs retrospective audits identifying overpayments, underpayments and system configuration issues.
  10. Identifies any inappropriate provider billing issues.
  11. Maintain proper accounting records, back up and reports

 

Requirements:

  • 5+ years experience in professional and institutional claims examining and/or auditing.
  • Excellent knowledge of CPT, RBRVS, DRG, HCPCS and ICD-9 coding and regulations.

 


 

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