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Job Details

Provider Reimbursement Auditor Claims Auditor - Military veterans preferred

Company name
Health Net, Inc.

Location
Farmington, MO

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Position Purpose: Perform comprehensive audits of provider claims to source documents and identify mis-payments. Conduct quality audits of provider claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
Analyze errors and determine root causes for appropriate classification
Utilize audit software to provide written documentation regarding audit observations
Analyze and review responses to audit observations and facilitate corrective action plans
Assist with providing updates to audit criteriaEducation/Experience: Associate\u2019s degree in related field or equivalent experience. 2 years of medical or pharmacy claims processing or claims pricing experience. Microsoft Office applications, Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts preferred. Knowledge of CPT/HCPCS Coding preferred.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Company info

Health Net, Inc.
Website : https://www.healthnet.com

Company Profile
Health Net's mission is to help people be healthy, secure and comfortable.

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