Hybrid Claims Auditor for Medicare/Medicaid Payments

American Health Partners; Indianapolis (IN); Hybrid; USD 65.000 - 90.000; Vollzeit

Benefits dieser Stelle

Affordable Medical/Dental/Vision

Generous paid time-off

TeleMedicine 24/7/365

Disability plans

Employee Assistance Plan

401K retirement

Referral Bonus

Zusammenfassung

American Health Plans is seeking a claims processing auditor to ensure accurate Medicare/Medicaid payments and denials, with strong CMS rule knowledge. The role involves audits, regulatory compliance, and collaboration with a delegated processor, with a hybrid schedule including onsite days in Franklin, TN.

Qualified candidates will have 2+ years in complex claims processing or auditing within the health insurance sector and familiarity with CPT4, ICD10, HCPCS coding.

Qualifikationen

• Two (2) years’ experience with complex claims processing and/or auditing in health insurance or healthcare delivery systems.
• Two (2) years’ experience in managed care environment related to claims processing/audit.
• Two (2) years’ experience with standard coding and reference materials used in a claim setting (CPT4, ICD10, HCPCS).
• Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility rules.

Aufgaben

• Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials.
• Ensure regulatory compliance and overall quality by knowledge of claims processing standards.
• Coordinate with delegated claim processor to review and correct errors before final payment.
• Handle claim projects to completion.
• Provide high level customer service to internal and external customers; meet quality and productivity goals.
• Escalate claims/audit issues to management and follow policies.
• Maintain production and quality standards set by management.
• Participate in ad-hoc audits as needed.
• Other duties as assigned.

Kenntnisse

Claims processing

CMS rules

Auditing

Customer service

Regulatory compliance

Communication

Tools

Automated claims processing systems

Jobbeschreibung

American Health Plans is seeking a claims processing auditor to ensure accurate Medicare/Medicaid payments and denials, with strong CMS rule knowledge. The role involves audits, regulatory compliance, and collaboration with a delegated processor, with a hybrid schedule including onsite days in Franklin, TN.

Qualified candidates will have 2+ years in complex claims processing or auditing within the health insurance sector and familiarity with CPT4, ICD10, HCPCS coding.