Claims Audit Analyst

WelbeHealth • Los Angeles, CA

23h

About The Position

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option (PACE) to the most vulnerable senior population while serving as a care provider and care plan to those individuals we serve. Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures.

Requirements

• Minimum of three (3) years of experience processing and auditing Medicare and Medicaid professional, institutional, and dental health insurance claims
• Experience working with CMS and Medicaid healthcare claims highly preferred
• Demonstrated skills within Microsoft Office Applications, including Excel
• COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment.
• WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Responsibilities

• Review processed claims for accuracy prior to payment while maintaining acceptable levels of claim’s aged inventory by verifying various aspects of the system and claim
• Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing errors, and monetary discrepancies
• Move claims free of processing errors through for full adjudication and return claims with errors back to the claims team for corrections
• Provide feedback to the Oversight & Monitoring Manager on claims processing errors, quality improvement opportunities, and configuration change requests, when applicable

Benefits

• Apply your claims expertise in meaningful ways as we rapidly expand.
• You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.
• Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
• Work/life balance – we mean it!
• 17 days of personal time off (PTO), 12 holidays observed annually, sick time
• Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path!
• And additional benefits
• WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits.
• Actual pay will be adjusted based on experience and other qualifications.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 501-1,000 employees