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Rancho Cucamonga

    Medical Needs Auditor - Rancho Cucamonga, CA, United States - Inland Empire Health Plan

    Inland Empire Health Plan
    Inland Empire Health Plan Rancho Cucamonga, CA, United States

    3 weeks ago

    Default job background
    Description

    Under the direction of the Claims Oversight Supervisor, the Internal Claims Oversight Auditor is responsible for ensuring the compliance of IEHP's claims payment system and processes by auditing claim payments using standard principles and State and Federal regulations.

    The auditors are also responsible for documenting and reporting findings and ensuring appropriate actions have been taken to resolve payment issues with the affected departments within IEHP, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.

    CalPERS retirement.
    Medical Insurance with Dental and Vision.
    Life, short-term, and long-term disability options
    Flexible Spending Account – Health Care/Childcare
    CalPERS retirement
    Four (4) years auditing claims in a managed care environment including contract and financial DOFR interpretation.
    Two years (2) claims processing including Medi-Cal and Medicare.
    Knowledge of Medi-Cal and CMS guidelines for claim payments.

    Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings.

    Microsoft Office including being able to manipulate large data sets in Excel files.
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