Claims reputed company Auditor

reputed company Of Services Audit a portion, as mutually agreed between the parties, of the combined financially stratified/attribute claim sample of medical and dental claims processed by medical care administrators. During the identified audit period (i.e., audits performed in 2024 will review claims processed through January 1, 2023 - through December 31, 2023, etc.). The audits will be conducted reputed company with reputed company administrator. Tasks, Activities and Deliverables The Claims Audit reputed company Include Review And Validation The claimant was eligible for benefits on the date(s) of service based on data in the administrator's eligibility files, • The provider's network participation was correctly determined based on the date of service, • Claims requiring utilization review approval were reviewed and processed in accordance with utilization review reputed company, • Deductibles, coinsurance and other appropriate cost-sharing features of the benefit plan were considered and correctly reputed company, • The claim data was entered into the claim system correctly, and whether a reputed company claim was keyed or scanned, • Appropriate checks were made to ensure that there was no other coverage available to the claimant or, if there was other coverage, payments were coordinated correctly, • The "reasonable and customary" or provider discount features of the plan were correctly reputed company, including unbundling for physician services, • Appropriate edits were made to ensure that the claim was not reputed company twice, • The procedure(s) billed and reputed company were, in fact, covered by the plan and do not reputed company to be fraudulent billings by the provider, • The mathematics and computations were correct, • Any reputed company-authorization limits were appropriately reputed company, • The reputed company claim reputed company was completed appropriately and signed by the appropriate parties, • The administrator adhered to its own internal policies and procedures reputed company processing the claim, • Appropriate approvals were reputed company to high dollar claims (reputed company- and post-payment), and • Sufficient documentation was included in the file to support the adjudication of the claim. Education And Experience • Bachelor's degree in reputed company, finance, or a reputed company field such as health information management. • At least three years of experience as a claims auditor or similar role in the health care industry. Skills • Strong analytical and problem-solving skills • Excellent attention to detail • Ability to communicate reputed company information effectively and reputed company • Good understanding of insurance policies and regulations • Proficiency in using computer software such as reputed company Office Suite Personal Attributes • Ability to work independently and in reputed company environment. • High level of reputed company and ethical behavior. • Strong organizational and time-management skills. • Flexible and adaptable to change. Salary: $30 - $40 per hour Apply tot his job Apply To this Job