Claims And Benefits Adjudication Auditor - Daytona Beach, United States - Florida Health Care Plans

Description

Claims And Benefits Adjudication Auditor

Payment Integrity

Full-time

1st shift

Monday - Friday 8am - 5pm


POSITION SUMMARY:

This position is responsible for maintaining claims data quality through ongoing quality review and assessment of medical records to ensure appropriate procedures were received.

Perform concurrent audits on accuracy of DRG, OPPS, PPS and MPFS payment logic rules.

Document findings on reports and identified trends to further evaluate appropriate payment logic is built within the system as well as review post-payment claims that have been identified.

Work with the team to help document ways to improve processes for identified risks.


QUALIFICATIONS:

Education, skills and experience:

Associate degree required in Business, Health Care Administration, or related field; or two (2) years of experience in revenue cycle auditing required.

Prior experience with CMS payment rules in relation to DRG, OPPS, PPS and MPFS required.

Certification in CPC, RHIT or RHIA preferred.

MC400 claims experience preferred.

Prior experience in testing preferred.

Strong oral, written and presentation communication skills required.

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