Senior External Claims Auditor
October 28
Description
• The Senior External Claims Auditor performs advanced health plan/DMHC/CMS audits, monitor trends, and perform special analyses. • Ensure health plan documents are submitted timely, identifying potential issues, and recommending strategies for resolution. • Monitor audit due dates and analyze complex project reports results directly to management. • Independently run reports on errors identified for potential error trends and report results to Claims management and Claims Trainer.
Requirements
• Minimum Education: A High School Diploma or Equivalent required. BS/BA preferred. • Minimum Experience: Previous two (2) years’ experience as Medical Claims Auditor or 7 years previous experience examining Claims required. Strong independent decision-making, influencing and analytical skills. Extensive knowledge of claims processing guidelines including, perspective payment systems, DRG payment systems, comprehensive coding edits, Medicare guidelines, and Medi-Cal guidelines.
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🇺🇸 United States – Remote
💵 $43.9k - $67.1k / year
🔥 Funding within the last year
💰 Private Equity Round on 2024-07
⏰ Full Time
🟡 Mid-level
🟠 Senior
🔎 Auditor