Claims Quality Auditor

University of California - Los Angeles Health; Los Angeles (CA); On-site; USD 43,408 - 86,292; Full time

Job summary

University of California - Los Angeles Health is seeking a Claims Quality Auditor to take on a vital role in a leading health organization. The auditor will perform daily audits on claims, ensuring accuracy, compliance, and adherence to policies. Candidates must have a high school diploma and four years of HMO claims payment experience, alongside proficiency in medical coding and terminology. A detail-oriented approach and strong organizational skills are essential for success in this position. Competitive hourly pay from $31.51 to $62.64 is offered.

Qualifications

• Four or more years of medical claims payment experience in an HMO environment.
• Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS.
• Knowledge of medical terminology and understanding of Medicare Guidelines.

Responsibilities

• Audit daily claims for accuracy and compliance.
• Research payment inquiries and compile statistical data.
• Maintain departmental production and quality standards.

Education

High school diploma, GED or equivalent

Tools

Microsoft Office

Job description

Description

Take on an important role within a world‑class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health.

The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor. You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures. You will:

• Research over and under-payment inquiries/appeals
• Compile and maintain statistical data consistent
• Maintain departmental production and quality standards

Salary Range: $31.51 - $62.64 Hourly

Qualifications

We're seeking a self‑motivated, detail-oriented, deadline‑driven individual with:

• High school diploma, GED or equivalent
• Four or more years of medical claims payment experience in an HMO environment
• Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS
• Understanding of Medicare Guidelines and COB
• Knowledge of medical terminology
• Experience in benefit determination and claims adjudication
• Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM
• Understanding of professional and facility reimbursement methodologies
• Strong organizational skills
• Computer proficiency with Microsoft Office
• Knowledge of claims adjudication systems
• Flexibility and adaptability