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Medical Claims Auditor

Location
San Francisco Bay Area

Employment Type
Full-Time (Hybrid 2 Days in office)

Position Summary
Responsible for the review and processing of regular claims using established claim standards and departmental policies and procedures ensuring that the work is performed accurately and delivered to meet set objectives.

Essential Duties & Responsibilities
• Accurately evaluates and adjudicates complex claims in a timely manner and according to set standards. Regular claims include but not limited to professional claims, Lab, DME, ambulance, as well as outpatient facility UB claims.
• Able to review and match authorization for the service.
• Assists in optimizing work flows, troubleshooting and problem solving to claims.
• Develop and maintains any/all necessary documentation for claims adjudication
• Identifies and resolves provider billing issues, including provider/vendor communication in writing.
• Ensures accurate interpretation of government laws, rules and any regulations, as well as internal organization guidelines.
• Research, accesses and utilizes on-line reference for claim issues and resolution.
• Assists with completion of claims audits conducted on TPA.
• Accepts and performs other duties as assigned, including frequent special projects.

Qualifications
• Good English (verbal and writing) is required.
• College preferred.
• Insurance claims and Healthcare administration background strongly preferred.
• Strong computer skills required. Any programming / database skill is highly preferred.
• Advanced MS Excel skills including pivots, vlookup, conditional formatting
• MS Access skills are highly preferred
• Very strong data analytical skills
• Very strong claims data analysis
• Strong claims reimbursement knowledge
• Claims auditing experience
• Strong mathematics skills

Physical requirements
Able to lift up to 30 pounds
Use proper body mechanics when handling equipment
Standing, walking and moving 50% of the day.

Base Pay Scale
Starting at $24.28/hour – $36.39/hour
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

Time:  Full time
Salary:  Hourly
Category:  Operations

Updated: 2/6/2024 6:39:06 PM