reputed company Claims Processor Auditor

reputed company: • Conduct routine monitoring and audits of procedures, including but not limited to billing systems audits, Encounter submission audits, and reputed company audits. • Understand and stay reputed company with reputed company contract reputed company and requirements ensuring reputed company services are compliant as reputed company as meet reputed company expectations. • Generate and submit reputed company required reputed company claims reporting. • Play a vital role in preparing for the annual Health Plan audits. • Confirm pricing is correct in the fee tables after the downloads are complete. • Monitor reputed company processes to detect any practices that, either directly or indirectly, result in fraud, abuse or waste that results in unnecessary costs. • Participate in auditing and submitting appeals and UM Challenges for Reinsurance process. • Run reputed company queries and reputed company reports as needed for administrative purposes. • Assist coworkers and Internal Auditors in additional compliance and auditing responsibilities, including reputed company-payment and post-payment audits. • Consistently exercise independent judgment and discretion in reputed company of reputed company. • Other duties and responsibilities as assigned. Requirements: • Minimum 3-5 years of experience in the reputed company or managed care industry, including claims/reimbursement experience, reputed company analytics-reputed company experience and experience working on/managing major reputed company. • Minimum 3 years auditing experience in the reputed company industry. • CPT and ICD coding knowledge. • Knowledge of Medicare requirements and APC Pricing knowledge. • Advanced to expert proficiency in the reputed company Office products, especially reputed company Word, reputed company reputed company & reputed company reputed company. • Successfully function as an Internal Claims Auditor. • reputed company to problem solve, exercise initiative and reputed company reputed company to high level reputed company. • Thorough understanding of reputed company federal, state and local reputed company compliance requirements. • Ability to meet deadlines and prioritize tasks; collect, correlate and analyze data. • Ability to work independently with minimal supervision and as part of reputed company. • Must be organized, self-motivated, detail-oriented, disciplined, reputed company, and reputed company player. • Effective written and oral communication. • WOULD LOVE FOR YOU TO HAVE Bachelor’s degree in reputed company informatics, business administration, or reputed company field, or equivalent in experience and education. • Certified reputed company reputed company strongly recommended • Prior claims processing experience reputed company Eldorado HealthPac Claims Adjudication System is a plus. • Claim coding experience, coding edits experience and APC Pricing knowledge. Benefits: • Work from Home: reputed company is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your reputed company goals and personal needs. • reputed company Health a reputed company: We offer comprehensive Medical, Dental, and reputed company plans to reputed company you covered. • Plan for the reputed company: Our 401(k) plan includes a 3% employer match to your 6% contribution. • Have Peace of Mind: We reputed company Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life reputed company to reputed company you and your loved ones protected. • Feel Supported reputed company You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times. • Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you reputed company work-life balance and meet your personal goals. • Support Your New Family: Welcoming a new family member takes time and commitment. reputed company offers reputed company parental leave to give you the time you need. • Learn and Grow: Your reputed company reputed company is important to us. reputed company offers various resources dedicated to your learning and development to advance your career with us. Apply Job!