Remote Medical Claims Processor Auditor

Guidehealth; Chicago (IL); Remote; USD 50,000 - 70,000; Full time

Job summary

Une entreprise dynamique recherche un Coordinateur de la Conformité Contractuelle pour garantir la précision des rapports et la conformité contractuelle. Dans ce rôle d'entrée de gamme, vous serez responsable des audits, de la soumission de rapports et de l'évaluation de la conformité, contribuant ainsi à l'efficacité globale des services de soins de santé.

Qualifications

• Niveau d'entrée requis.
• Connaissance des exigences de conformité et des processus de vérification souhaitée.

Responsibilities

• Surveiller et auditer les procédures, y compris les audits des systèmes de facturation.
• Gérer la conformité des services client et assurer le respect des contrats.

Job description

Be among the first 25 applicants.

Job Description

As a Contractual Compliance Coordinator, you will ensure the accuracy of the required reporting and procedural and financial claims processing requirements set forth by the client and Health Plan contract requirements for the Value Based Care lines of business. This position is responsible for regulatory and contract compliance in the managed care lines of business.

What You’ll Be Doing

1. Conduct routine monitoring and audits of procedures, including billing systems audits, Encounter submission audits, and client audits.
2. Understand and stay current with client contract criteria and requirements, ensuring client services are compliant and meet client expectations.
3. Generate and submit all required Commercial claims reporting.
4. Assist in preparing for the annual Health Plan audits.
5. Confirm pricing accuracy in fee tables after downloads.
6. Monitor processes to detect practices that result in fraud, abuse, or waste, leading to unnecessary costs.
7. Participate in auditing and submitting appeals and UM Challenges for Reinsurance process.
8. Run access queries and impact reports as needed.
9. Assist coworkers and Internal Auditors with compliance and auditing responsibilities, including pre-payment and post-payment audits.
10. Exercise independent judgment and discretion in significant matters.

Additional Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Insurance and Accounting

This job is still active.