Medical Claims Auditor - 6-month contract (60584)

California  ‐ Onsite
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Description

MEDICAL CLAIMS AUDITOR

Contract: 6 months (W2)

Location: Pasadena, CA 91103

Job Number: 60584

Client: One of the country's largest health care and health plan providers

Job Description:

  • The main task of this role will be to audit Large Group Encounters to ensure the integrity of the adjudication of internal claims by auditing service-related information and invoice adjudication/payment for compliance with contract terms and Department/Regional policy and procedures.
  • The auditor must be thoroughly familiar with medical systems and claims processing/adjudication processes.
  • The position requires research, problem resolution and specialized knowledge in understanding what drives adjudication to certain benefits.
  • The auditor must also be capable of developing a working relationship with Revenue Cycle and Health Plan partners.
  • Role will be expected to track and update spreadsheets on status of audit and prepare/present presentations on Quality related to findings and offer process improvement recommendations.

Required Education, Experience, and Skills:

  • Bachelor's degree in related field or equivalent combination of experience
  • Minimum 3-5 years claims auditing experience
  • Certification in medical terminology
  • Expert competency in MS Applications (Excel, PowerPoint)
  • Demonstrates excellent verbal, written, and interpersonal communication skill and communicates thoughts clearly and concisely
  • Negotiates conflict and difficult situations with tact and candor
  • Asks direct questions and listens carefully to responses, restating to clarify understanding
  • Pro-actively creates opportunities for open, two-way communication with others
  • Excellent presentation and facilitation skills

Preferred Education, Experience, and Skills:

  • Additional 3-5 years claims processing
  • Minimum 2 years medical coding experience
Start date
late June
Duration
6 months
From
Enclipse Corp.
Published at
16.06.2015
Project ID:
924765
Contract type
Freelance
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