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Claims Auditor

Company: Innovative Management Systems Incorporated
Location: Whittier
Posted on: January 25, 2023

Job Description:

The Claims Auditor is responsible for reviewing all processed claims accuracy prior to payment release and is the lead responder to Health Plans and IMS Clients for all products and lines of business. They will be responsible for management and monitoring of claims compliance with all products and lines of business for managed care claims payments. This person is the liaison and resource for our clients and claims examiners to resolve claim processing issues.

Some major duties include:
To perform, assist and train for daily audits of claims payment as established in the Claims Department Policies and Procedures.
Read and analyze EOBs and make proper adjustments according to claims processing criteria.
Audit pre-check runs based on check run schedules.
Run and resolve various claims reports prior to check run.
Responsible for being the main resource for all appeals to insurance carriers with justification as to why treatment should be paid.
Audit and monitor accounts to ensure proper fees have been posted.
Work with team to maximize office collections and minimize adjustments.
Communicate issues and suggestions to improve processes.
Resolve claims based on CCI edit report to comply with CMS guidelines.
Ensure compliance with Company Policies as well as State, Federal and other regulatory bodies.
and much more.

Pay Range: Starting $26 - $30 per hour or competitive compensation
Full Time, Benefits Eligible

Our Company:
Our team at IMS is looking for highly motivated individuals to join our growing start-up. We strive to innovate the healthcare industry by providing management and consultant services to Independent Physicians Associations (IPAs) and Health Plans. Our team utilizes their comprehensive knowledge of the healthcare industry to provide quality services for our contracted Medicare members in a fast-paced and multi-faceted environment. Our positions offer an in-depth perspective of the managed care industry to interested candidates that are looking to take risks and share in professional development and growth alongside our expanding company. If you are looking to make an impact in your career, in a flourishing new company, and in the healthcare industry, we welcome you to apply to join our team!

2+ years in Claims Department of an IPA, Health Plan, Managed Service Organization.
1 - 2 years experience in a call center environment.

Knowledge, Skills, Abilities, Other Characteristics:
Knowledge of Healthcare regulations and guidelines including CMS, DMHC, DHS.
Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms and CPT Coding.
Technical and computer expertise.
Communication - abilities to identify and effectively communicate unresolved problems to Management in a timely manner.
Demonstrates high reliability through consistent punctuality and attendance.
Ability to work with minimal supervision.

Associate Degree (AA) or 2 - 3 years of related experience and/or training or equivalent combination of education and experience.


Keywords: Innovative Management Systems Incorporated, Whittier , Claims Auditor, Accounting, Auditing , Whittier, California

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