Claims Compliance Auditor I
EMS Management and Consultants Inc
Rancho Cordova, CA, USA
Published 1 week ago
Audit
Full time
Job Type
Full-time
Description
Under the supervision of the Division Manager, the Claims Compliance Auditor must have a minimum of six months experience at Wittman Enterprises. They will have working knowledge of all insurance payors including managed care plans. Proficient in all other software systems utilized to manage work. Must have written and oral skills. Must be able to maintain mail, workflows, and other duties as assigned by the Management staff.
Work Schedule
This position has a work schedule of five days and 40 hours/week. Duties are performed 12 months a year. May be required to work overtime as needed.
Role and Responsibilities
• Maintain all incoming denials and correspondence from insurance companies.
• Monitor and provide feedback on the status of denials received from insurance companies.
• Report any unusual denials that may affect or delay revenue.
• Take insurance incoming calls
• Follow-up on static claims
• Functional knowledge of the Billing system.
• Maintain working knowledge of Insurance rules/regulations to ensure accurate and timely billing and payment of claims.
• Maintain interface with all Payors on matters relating to billing issues, including telephone contact and correspondence.
• Interact with Division Manger as well as other Managerial staff.
• Adhere to all company policies and procedures.
• Perform other duties as assigned.
Requirements
Be proficient in word processing and spreadsheet software. Demonstrate ability to be objective, pro-active, assertive, and diplomatic to effectively interact with all departments. Knowledge and experience with Medicare, Medicaid, private insurance plans, Champus/TriCare, Workers Compensation, and other third party payers. Have general knowledge of condition codes, ICD9, CPT, and HCPCS codes. Have knowledge of medical terminology and regulatory compliance requirements.
Preferred Skills
Typing a minimum of 35 WPM
Flexibility
Customer Service
Dependability
Problem Solver
Communication skills
Detail oriented
Multi-tasking
Self- Motivator
Ability and willingness to accept change
Follow direction
Productivity of (60 to 80 per day)
General working knowledge of PCs and/or patient accounting computer system.
Full-time
Description
Under the supervision of the Division Manager, the Claims Compliance Auditor must have a minimum of six months experience at Wittman Enterprises. They will have working knowledge of all insurance payors including managed care plans. Proficient in all other software systems utilized to manage work. Must have written and oral skills. Must be able to maintain mail, workflows, and other duties as assigned by the Management staff.
Work Schedule
This position has a work schedule of five days and 40 hours/week. Duties are performed 12 months a year. May be required to work overtime as needed.
Role and Responsibilities
• Maintain all incoming denials and correspondence from insurance companies.
• Monitor and provide feedback on the status of denials received from insurance companies.
• Report any unusual denials that may affect or delay revenue.
• Take insurance incoming calls
• Follow-up on static claims
• Functional knowledge of the Billing system.
• Maintain working knowledge of Insurance rules/regulations to ensure accurate and timely billing and payment of claims.
• Maintain interface with all Payors on matters relating to billing issues, including telephone contact and correspondence.
• Interact with Division Manger as well as other Managerial staff.
• Adhere to all company policies and procedures.
• Perform other duties as assigned.
Requirements
Be proficient in word processing and spreadsheet software. Demonstrate ability to be objective, pro-active, assertive, and diplomatic to effectively interact with all departments. Knowledge and experience with Medicare, Medicaid, private insurance plans, Champus/TriCare, Workers Compensation, and other third party payers. Have general knowledge of condition codes, ICD9, CPT, and HCPCS codes. Have knowledge of medical terminology and regulatory compliance requirements.
Preferred Skills
Typing a minimum of 35 WPM
Flexibility
Customer Service
Dependability
Problem Solver
Communication skills
Detail oriented
Multi-tasking
Self- Motivator
Ability and willingness to accept change
Follow direction
Productivity of (60 to 80 per day)
General working knowledge of PCs and/or patient accounting computer system.