Claims Auditor - LH

Luminare Health

1d

About The Position

This role is responsible for the evaluation, development, running, and/or providing testing updates. Scope of testing support includes project-driven enhancements, routine updates/requests for change and other enhancement activities where testing is deemed critical to Operational success, in adherence with company and industry quality standards. Role includes analysis of features/components/etc. and identification of enhancement opportunities.

Requirements

• Bachelor’s degree or equivalent experience required
• At least 4-5 years or more experience in claim processing.
• Specific knowledge of claims and processes in a Commercial BC/BS HMO organization.
• Proficient in MS Office applications: Outlook, Excel, Word, Access, and PowerPoint
• Extensive Knowledge of CPT 4, HCPCS, UB-04 and ICD-10 coding.
• Medical terminology knowledge
• Excellent interpersonal, oral and written communication skills
• Strong attention to detail and organization
• Able to work independently; strong analytic skills
• Strong computer skills
• Requires flexibility, to be able to switch priorities in positive and effective manner when directed by network leadership.
• Ability to meet deadlines.
• Must be able to work in fast paced sometime stressful environment

Nice To Haves

• Specific knowledge of claims and processes in a Commercial BC/BS HMO organization.
• Proficient in MS Office applications: Outlook, Excel, Word, Access, and PowerPoint
• Extensive Knowledge of CPT 4, HCPCS, UB-04 and ICD-10 coding.
• Medical terminology knowledge
• Excellent interpersonal, oral and written communication skills
• Strong attention to detail and organization
• Able to work independently; strong analytic skills
• Strong computer skills
• Requires flexibility, to be able to switch priorities in positive and effective manner when directed by network leadership.
• Ability to meet deadlines.
• Must be able to work in fast paced sometime stressful environment.

Responsibilities

• Pre-check run auditing on various reports prior to finalizing the check run. Works within timelines for auditing and manage all auditing according to schedule
• Provide assistance with all Health Plan claim audits. Provide feedback to Management and Staff regarding auditing results
• Complete Claims Appeals and 095 processes according to health plan and company guidelines in accordance with established timeframes.
• Assist in establishing and communicating new and existing policy and procedures.
• Enhance department productivity by recommending improvements to workflow processes and organizational structure.
• Develops corrective action plans and participates in compliance investigations as needed.

Benefits

• health and wellness benefits
• 401(k) savings plan
• pension plan
• paid time off
• paid parental leave
• disability insurance
• supplemental life insurance
• employee assistance program
• paid holidays
• tuition reimbursement
• annual incentive bonus plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees