Claims Auditor

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $29 - $45 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

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👻 Ghost score 0%

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Providence

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1856

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Providence is a not-for-profit health system committed to providing a wide range of medical services, including primary care, urgent care, pediatrics, maternity care, cancer treatment, and specialized services like neurosurgery and orthopedics. They offer both in-person and virtual care through clinics and a mobile app, ensuring patients can access healthcare conveniently. With a mission rooted in compassion, dignity, and justice, Providence emphasizes serving those who are vulnerable and strives for excellence in healthcare delivery. They are involved in research and innovation, including genomic profiling and clinical trials to improve patient outcomes.

📋 Description

• Maintain managed care health plan delegated auditing functions • Review pre- and post-payment claims • Document assigned errors • Report claims processing errors • Provide feedback to ensure compliance with health plans and regulatory agencies • Conduct routine and complex audits to identify exceptions to claims adjudication requirements • Secure data integrity and maintain accuracy standards for claims processing, payment, and procedural accuracy • Report to the Supervisor, Claims Audit

🎯 Requirements

• 3 years of claims processing experience in a managed care environment • 1 year of claims audit experience (preferred) • Experience processing Medicare, Medi-Cal, or One Care Connect claims (preferred) • Knowledge of CMS, DMHC, and DHCS regulatory requirements

🏖️ Benefits

• Retirement 401(k) Savings Plan with employer matching • Medical, dental, and vision health care benefits • Life insurance • Disability insurance • Paid parental leave • Vacation time • Paid holidays • Time off for health issues • Voluntary benefits • Well-being resources • Additional compensation may be available, including shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities