Claims Auditor
$61,693 - $89,461/Yr
HCA Healthcare - Campbell, CA
posted about 2 months ago
Part-time,Full-time - Mid Level
Remote - Campbell, CA
10,001+ employees
Hospitals
About the position
The Claims Auditor will serve as a Subject Matter Expert (SME) in medical claims processing, ensuring payment accuracy for all claims processed. This role involves analyzing workflows, providing feedback, and conducting training based on audit findings to improve overall claims processing efficiency.
Responsibilities
- Perform concurrent and retrospective review of paper & electronic claims processed.
- Review routine random sampling audit of examiner processed claims for accuracy and provide feedback to the examiner.
- Review support team workflows to ensure regulatory timeliness, distribution, and accuracy guidelines are met.
- Report metric volume, procedural and financial accuracy on a recurring schedule to claim management.
- Identify root cause of system and/or examiner errors and report to claim leadership for corrective action.
- Partner with claim management on performance management recommendations.
- Conduct weekly reviews of high-dollar claims.
- Review and analyze audit data, including trend results, and recommend process changes, refresher training, and system enhancements.
Requirements
- High school diploma required; Bachelor's degree preferred.
- 4 - 5 years' experience as a Senior Claim Examiner in a managed care environment required.
- Hands-on knowledge and functional understanding of medical claims billing, processing, terminology, diagnosis, and procedures.
- Technical proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, PowerPoint.
- Solid knowledge of ICD-10, CPT-4, HCPCS, Revenue Codes, UB-04, and CMS-1500 forms.
- Customer service skills required.
Benefits
- 401(k) matching
- Adoption assistance
- Dental insurance
- Disability insurance
- Employee stock purchase plan
- Family leave
- Flexible spending account
- Comprehensive medical coverage
- Free telemedicine services
- Free AirMed medical transportation
- Additional options for dental and vision benefits
- Life and disability coverage
- Supplemental health protection plans
- Auto and home insurance
- Identity theft protection
- Legal counseling
- Long-term care coverage
- Moving assistance
- Pet insurance
- Free counseling services
- Education assistance
- Colleague recognition program
- Time Away From Work Program
- Employee Health Assistance Fund
