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Production Claims Auditor

Pittsburgh, PA

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Production Claims Auditor
Production Claims Auditor
job details:
location:Pittsburgh, PA
salary:$30 per hour
date posted:Tuesday, June 12, 2018
job type:Temp to Perm
industry:Professional, Scientific, and Technical Services
job description
Production Claims Auditor
Primary Responsibilities:
Audit paid claims data to identify duplicate payments or contractual, billing, and claim processing errors
Initiate phone calls to providers, employer groups, and other insurance companies to gather pertinent claim information, such as verification of billed charges, confirmation of services received, and coordination of benefits information
Work directly with other departments to enhance and refine assigned inventory to maximize value
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Use pertinent data and facts to identify and solve a range of problems within area of expertise
Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
Investigate and identify over-payments on all claims types, as well as assist in recovery and resolution for health plans, commercial customers, and government entities as needed
Minimum Needed Qualifications
2 years of experience with claims auditing and researching claims information
1 years of experience analyzing data and identify cost saving opportunities
Experience working with medical claims platforms
Knowledge of Medicaid / Medicare Reimbursement methodologies
Knowledge of claims processing systems and guidelines / processes
Understanding of Payment Methodologies like Stop Loss also known as provider excess loss
CPC Certification or understanding
SME within their department
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