Claims Auditor
Every day All Medical Personnel helps exceptional people like you find positions with outstanding medical and healthcare organizations. Whether you desire the flexibility and diversity of temporary assignments or are seeking a full-time career challenge, we can help you find the perfect position-where your skills and experience will be appreciated and showcased. Our clients include local medical offices, regional hospitals, and Fortune 1000 businesses nationwide.
Claims Auditor
Position Duties May Include:
- Performs individual claims audits on the Claims staff to ensure accuracy of claims processed
- Conducts payment/EOB audits on all EOB’s generated by the Claims Department
- Reviews and Audits the provider File as a subset of the Claims Audits
- Creates, maintains and upholds the weekly, monthly & annual audit reports of the Claims staff performance to Claims Management
- Processes & adjudicates the claims for accounts requiring multiple disciples in claims processing to include COB, Adjustments, Offsets, refunds and claims appeals
- Advisor to Claims Management and the Claims trainer with regards to areas of deficiency in order to effectuate in-service training sessions to the claims staff
- Recognizes claims issues/problems, refers them to management and/or appropriate party, and assists in the review and implementation of resolution
- Maintains production and quality standards established by the Claims Department
- Assists management and all staff in their daily work as needed or as necessary
Requirements:
- High school diploma or general education degree (GED; or 5 years related experience and/or training; or equivalent combination of education and experience
- Minimum of 5 years experience in a Medical Claims processing environment performing claims adjudication with varying levels of difficulty
- Strong knowledge of Florida Medicare, Florida Medicaid and Florida Statutory claims guidelines
- Prior claims adjudication experience with HMO, PPO, POS, Commercial, Medicare and Medicaid lines of business.
Benefits:
-Competitive salary commensurate with experience
-Medical/Dental
-Weekly Pay
-Direct Deposit
-Referral Bonuses
-Childcare reimbursement
Getting started is easy
Email your resume as an attachment in .doc format to
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