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Claims Auditor
2 weeks ago
Innovative Management Systems, Inc. La Puente, United StatesJob Type · Full-time · Description · THE POSITION. · This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products a ...
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Claims Auditor
3 weeks ago
Innovative Management Systems Incorporated City of Industry, CA, United States: · THE POSITION. · This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible ...
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Claims Auditor
3 weeks ago
Innovative Management Systems Incorporated Hacienda Heights, United States: THE POSITION. · This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible for ...
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Claims Auditor
2 weeks ago
Innovative Management Systems Incorporated Hacienda Heights, United States Full time: THE POSITION. · This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible for ...
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Claims Auditor
3 weeks ago
Innovative Management Systems Incorporated City of Industry, United States:THE POSITION. · This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible for m ...
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Claims Auditor
2 weeks ago
Innovative Management Systems Incorporated City of Industry, United States:THE POSITION. · This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible for m ...
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Claims Auditor
3 weeks ago
Innovative Management Systems Incorporated Whittier, United States: · THE POSITION. · This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible fo ...
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Claims Auditor
4 days ago
Providence Health & Service Anaheim, United StatesThe Claims Auditor performs various audits of claims payments and denials to ensure accuracy based on the DOFR, internal policies and procedures and regulatory requirements. Providence caregivers are not simply valued theyre invaluable. Join our t Auditor, Claims, Audit, Accounti ...
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Claims Auditor
1 week ago
Alta Hospitals Orange, United StatesThe Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim ...
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Claims Auditor
4 days ago
Prospect Medical Holdings Orange, United StatesThe Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim ...
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Claims Auditor
1 week ago
Prospect Medical Holdings Orange, United StatesJob Description · The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resol ...
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Claims Auditor
1 day ago
Providence Health & Service Anaheim, United StatesJob Description · The Claims Auditor performs various audits of claims payments and denials to ensure accuracy based on the DOFR, internal policies and procedures and regulatory requirements. · Providence caregivers are not simply valued - they're invaluable. Join our team at P ...
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Claims Auditor
2 days ago
Providence Health & Service Anaheim, United StatesThe Claims Auditor performs various audits of claims payments and denials to ensure accuracy based on the DOFR, internal policies and procedures and regulatory requirements. · Providence caregivers are not simply valued – they're invaluable. Join our team at Providence Medical Fo ...
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Intermediate Medical Claims Quality Auditor Ii
2 weeks ago
Kaiser Permanente Downey, United States**Job Summary**: · Remote from any KP location in CA, OR, CO, WA, GA, MD, VA, HI or D.C. Only. · Quality Claims Auditor: This position exists to ensure the integrity of medical payments for the organization through verification of the accuracy of data-entered information and by a ...
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Claims Auditor
2 weeks ago
Alta Hospitals Orange, United StatesWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute ...
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Claims Auditor
5 days ago
Regal Medical Group Los Angeles, United StatesJob Description · This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHS. This position includes the responsibility ...
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Claims Auditor
2 weeks ago
TEKsystems Los Angeles, United States: · This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHS. This position includes the responsibility for routine h ...
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Claims Oversight Auditor
1 week ago
IEHP Rancho Cucamonga, United States OTHERWhat you can expect · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience · Under the direction of the Claims Oversight Supervisor, the Internal Claims Oversigh ...
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Claims Oversight Auditor
1 week ago
Inland Empire Health Plan Rancho Cucamonga, United StatesWhat you can expect · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience · Under the direction of the Claims Oversight Supervisor, the Internal Claims Oversig ...
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Claims Quality Auditor
2 weeks ago
University of California Los Angeles, United StatesTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health. · The Claims Quality Auditor will be ...
Claims Auditor - West Covina, United States - Regal Medical Group
Description
Job DescriptionPosition Summary:
This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHS.
This position includes the responsibility for routine hospital and professional audits, complex audits on individual or random, training and focused claims to identify exceptions to established claims adjudication requirements for claims processing, payment and procedural accuracy.
In addition, this position is responsible to assist with eligibility identify (e.g. COB, ESRD) and Letters of Agreements as required. To maintain in strict confidence, all member, provider and Health Plan information to which Claims Auditing Specialist has access.Essential Duties and Responsibilities include the following:
Performs routine and complex audits on individual, random, trainee and focused claims to identify exceptions to established claims adjudication requirements for both Pre-EOB and post payment.
Researches claim processing problems and errors to determine their origin and appropriate resolution.
Researches member activity to identify Coordination of Benefits, Third Party Liability, Out-of-Area and Workers' Compensation as identified through member admissions, authorization process or claims activityNotify management immediately if any report processing deadlines cannot be met.
Identify, proactively through auditing and internal reporting, negative and positive trends and initiate recommendations for changeAnalyze data processing reports and make necessary corrections or adjustmentsAssist with training of claims adjudication staff as neededAssist manager with follow-up on any problems or questions related to the audit resultsOther duties as assigned
The pay range for this position at commencement of employment is expected to be between $22.50 per hour to $24.50 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment.
Full Time Position Benefits:
The success of any company depends on its employees.
For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.
As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employeesVision insuranceZero co-payments for employed physician office visitsFlexible Spending Account (FSA)Employer-Paid Life InsuranceEmployee Assistance Program (EAP)Behavioral Health Services
Savings and Retirement:
401k Retirement Savings PlanIncome Protection Insurance
Other Benefits:
Vacation TimeCompany celebrationsEmployee Assistance ProgramEmployee Referral BonusTuition ReimbursementLicense Renewal CEU Cost Reimbursement ProgramBusiness-casual working environmentSick daysPaid holidaysMileage
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Education and/or Experience
High School graduation.
Possess strong knowledge of CPT, ICD, HCPCS, DRG coding and claims adjudication for hospital and professional claims.
Knowledge of medical terminology.
Prefer 5 years previous experience with adjudication all types of claims.
Basic level proficiency with Microsoft Office applications including Word, Excel, PowerPoint.
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