Healthcare Claims Audit Specialist

KabaFusion; Cerritos (CA); Sur place; USD 33 000 - 39 000; Plein temps

Avantages offerts par ce poste

Competitive compensation

Benefits start on your 1st day of work

401k with 4% match

PTO / Floating Holidays / Paid Holiday

Company paid life insurance, short–/±1

Employee Assistance programs

Learning & Development Programs

Discounts on travel, cell phone, and ۔

Résumé du poste

KabaFusion is seeking a Medical Records Claims Auditor in Cerritos, CA. This full-time role evaluates, tracks, audits, and monitors billing processes to ensure accurate claims and regulatory compliance.

You will liaison with the reimbursement department, manage payer audit requests, identify discrepancies, and ensure timely, HIPAA-compliant reporting across internal teams.

Qualifications

• Knowledgeable and understanding of HCPC and CPT codes.
• Demonstrate the ability to manage tasks independently, with minimum supervision.
• Demonstrate the ability to meet deadlines.
• Strong understanding of insurance terms, medical terminology, pricing methodologies for commercial and government billing requirement.

Responsabilités

• Acts as a liaison between the reimbursement department and various other departments throughout the organization to audit, monitor, track and resolve reimbursement issues.
• Responsible for processing and managing audit requests from payers assuring all required documentation is on file and submitted by the deadline for successful results.
• Responsible for identifying and reporting pharmacy document discrepancies and reporting them to Director of Reimbursement or other management team members.
• Audits pharmacy online claims for accuracy and correct claim submission for accurate reimbursement.
• Assures billing processes are compliant with payer requirement for Government, Commercial Health Plans and Medical Group payers.
• Communicates and addresses reimbursement issues with management for resolution in a timely manner.
• Responsible for the processing of all internal audits conducted by the board of directors and investors, ensuring effective completion and positive outcomes.
• Responsible for responding to and completion of all Subpoenas and Medical Record requests, including working with attorney offices or third-party Document Management companies.
• Must be able to prioritize, multi-task, meet goals and deadlines.
• Protects patient health information by following regulations for HIPAA compliance.
• Other related duties as assigned by manager or designee.

Connaissances

HCPCS/CPT codes

Task management

Deadline-driven

Insurance terminology

Formation

High school diploma or equivalent

Outils

Microsoft Office Suite

CPR+ software

Description du poste

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Medical Records Claims Auditor

BILLING & COLLECTIONS - Reps, CORP Full Time Cerritos - CA Cerritos - CORP - HOLDINGS, Cerritos, CA, US

30+ days ago Requisition ID: 4308

Salary Range: $24.00 To $28.00 Hourly

Come join an exciting and innovative company that puts the “care” back in healthcare!

At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.

About Us:

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion. c

JOB SUMMARY:

This position is responsible for is responsible for evaluating, tracking, auditing, and monitoring processes as they relate to billing to assure accurate claims and compliance.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Acts as a liaison between the reimbursement department and various other departments throughout the organization to audit, monitor, track and resolve reimbursement issues.

2. Responsible for processing and managing audit requests from payers assuring all required documentation is on file and submitted by the deadline for successful results.

3. Responsible for identifying and reporting pharmacy document discrepancies and reporting them to Director of Reimbursement or other management team members.

4. Audits pharmacy online claims for accuracy and correct claim submission for accurate reimbursement.

5. Assures billing processes are compliant with payer requirement for Government, Commercial Health Plans and Medical Group payers.

6. Communicates and addresses reimbursement issues with management for resolution in a timely manner.

7. Responsible for the processing of all internal audits conducted by the board of directors and investors, ensuring effective completion and positive outcomes.

8. Responsible for responding to and completion of all Subpoenas and Medical Record requests, including working with attorney offices or third-party Document Management companies.

9. Must be able to prioritize, multi-task, meet goals and deadlines.

10. Protects patient health information by following regulations for HIPAA compliance.

11. Other related duties as assigned by manager or designee.

JOB REQUIREMENTS AND QUALIFICATIONS

Education:

• High school diploma or equivalent.

Experience:

•Minimum of one (1) year experience in home infusion.

•Proficient experience with Microsoft Office including Word, Excel, PowerPoint, Outlook, Teams, and CPR+ software system or similar system preferred.

Skills and Competencies:

• Knowledgeable and understanding of HCPC and CPT codes.
• Demonstrate the ability to manage tasks independently, with minimum supervision.
• Demonstrate the ability to meet deadlines.
• Strong understanding of insurance terms, medical terminology, pricing methodologies for commercial and government billing requirement.

What we offer:

• Competitive compensation
• Benefits start on your 1stday of employment
• 401k w 4% match – no waiting or vesting period
• PTO / Floating Holidays / Paid Holidays
• Company paid life insurance, short term disability
• Employee Assistance programs to help with mental health / wellness
• Learning & Development Programs
• Perks… includes discounts on travel, cell phone, clothing and more…

Join us and find out why this is the place to excel and do your best work.