Company: Innovative Management Systems Incorporated
Posted on: January 25, 2023
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
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
Audit and monitor accounts to ensure proper fees have been
Work with team to maximize office collections and minimize
Communicate issues and suggestions to improve processes.
Resolve claims based on CCI edit report to comply with CMS
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
Full Time, Benefits Eligible
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
1 - 2 years experience in a call center environment.
Knowledge, Skills, Abilities, Other Characteristics:
Knowledge of Healthcare regulations and guidelines including CMS,
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
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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