Senior Claims Audit & Training Lead

Providence; Los Angeles (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Providence is seeking a leader to manage the claims internal audit functions, overseeing audit processes for adjudicated claims and encounters, and ensuring accuracy of check runs. You will develop policies for periodic audits to meet state and federal requirements, including AB1455 tracking and provider dispute resolution considerations.

Join Providence Clinical Network in a role that designs and implements training programs, adapts to policy changes, and ensures compliance across affiliated

Qualifications

• 5 years professional and facility claims processing experience.
• Familiar with State and Federal claim payment and denial timeliness legislation.
• Familiar with Provider Dispute Resolution AB1455 tracking mechanism.

Responsibilities

• Manage the claims internal audit functions, including audit process for adjudicated claims and encounters.
• Monitor check run processes for accuracy.
• Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements.
• Design, plan, direct and implement claims training programs for the organization, including adaptations to changes in policies, procedures and technologies.

Job description

Providence is seeking a leader to manage the claims internal audit functions, overseeing audit processes for adjudicated claims and encounters, and ensuring accuracy of check runs. You will develop policies for periodic audits to meet state and federal requirements, including AB1455 tracking and provider dispute resolution considerations.

Join Providence Clinical Network in a role that designs and implements training programs, adapts to policy changes, and ensures compliance across affiliated