Quality Control Auditor (medical claims) - 5 months (78604)

California  ‐ Onsite
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Description

Quality Control Auditor (medical claims)

Duration: 5-month assignment

Location: Rancho Cucamonga, CA 91730

Job Number: 78604

Position Summary:

Ensures the integrity of outside medical payments for the Organization through verification of the accuracy of data-entered information and by auditing service related information and invoice adjudication/payment for compliance with contract terms and Department and Regional Policies and Procedures.

Duties:

  • Auditing complex medical claims for our OPA population and high dollar claims
  • Reviewing rebuttals to audited claims by the auditor
  • Auditing Hospital and Medical office encounters daily, and provides findings to the Director
  • Ensures that audit staff tests payments for accuracy according to departmental policies and management guidelines
  • Traces sources of inaccuracies; reports and proposes remedial action to appropriate management
  • Ensures charity Care (MFA) encounters
  • Prepares formal statistical summaries to department manager of findings and recommendations

Required Education, Experience, and Skills:

  • Bachelor's degree, or equivalent experience, in Business Administration or related field
  • 2-3 years' claims processing experience and auditing experience
  • Proficient knowledge of computers, Word, Excel
  • Strong mathematical skills
  • Medical terminology and knowledge of medical billing practices
  • Good oral and written communication skills
  • Works well with team members
  • Flexible
  • Willing to do what it takes to get the job done accurately

Desired Experience and Skills:

  • Prior experience in account payable/claims environment
  • 3+ years medical claims processing experience on multiple products such as HMO, PPO, POS, Traditional/Indemnity, etc. as well as various pricing fee schedules (eg, DRG, Stoploss, Transplant, etc.)
  • 5+ years medical claims auditing experience in auditing all products (eg, HMO, PPO, POS, Medi-Cal, Medicare, etc.) Property & Casualty claims processing experience does not qualify
Start date
late July
Duration
5 months
From
Enclipse Corp.
Published at
08.07.2016
Project ID:
1163273
Contract type
Freelance
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