Medical Claims Auditor - 6-Month Contract (60584)

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