Claims Auditor


Rancho Cucamonga, CA

What you'll be doing

Audit and tests payments for accuracy according to established guidelines and provides education/feedback as applicable. Traces sources of inaccuracies; reports and proposes remediation action to appropriate manager. Prepares and maintains detailed reports of audit findings and submits reports/findings as requested. Cross trained in all audits including high dollar claims audits and releases. Ensures safeguarding of assets through the verification of documentation, approvals and accurate coding of provider service and accounting data. Monitors and coordinates special transactions such as check adjustments and credits. Performs audit of data entered for outside medical payments for the purpose of performance feedback. Formats and prepares statistical reports and works close with CAD and local finance department to determine causes of errors and achieve corrective action. Ensures accurate recording of outside medical utilization data by testing for appropriate and consistent invoice coding. Performs special comprehensive audits as indicated or requested by management.

What your background should be

Health care with two (2) years of auditing and medical billing experience is required. Knowledge of CPT, ICD, RBRVS and other applicable references. Demonstrated knowledge of both mainframe and personal computer programs. Excellent mathematical, written and verbal skills and demonstrated medical terminology competence. A proven ability to think and act independently and professionally. Able to understand, develop and implement procedures. Must be able to work in a labor/management partnership environment.

Required Schooling / Training

High school diploma or general education development (GED) required. Bachelor's degree in accounting, audit, finance or management.

Who is the client company

This is an integrated and the largest managed care organization in the United States.
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