Claims Examiner/Auditor

TEKsystems•Los Angeles, CA

9d•$24 - $24•Onsite

About The Position

The Claims Examiner is responsible for performing activities related to benefit analysis and system design, managing special projects, claim denials, and auto-adjudication applications, as it pertains to auditing and claims compliance. This includes oversight of all workflow, research, and documentation under limited supervision from Claims management. The incumbent identifies potential company risks, implements appropriate courses of action, and develops strategies to reduce adjudication errors. The role analyzes all relevant information to track and trend the outcomes of special projects, providing findings to the appropriate management.

Requirements

5 years working knowledge of claims processing and system configuration, preferably EZCap or like systems in the healthcare system
Strong ability to collaborate with management and other project managers to define business process issues, analyze operational efficiencies, implement creative solutions, and measure delivery results
Should exhibit a disciplined, process and data-driven approach and methodology.
Knowledge of claims processing and regulatory agencies requirements preferred.
Requires strong organizational, communication and written skills.
Must be able to function with minimal supervision and be able to prioritize all work tasks.
Demonstrated ability to conduct and interpret qualitative and quantitative analysis and problem-solving skills.
Ability to work well with individuals in all levels of the organization; must be an effective team player
Demonstrated ability to exercise initiative, independent judgment and be a self-starter.
Strong PC-based business software skills including MS Office suite (Access, Excel, PowerPoint, Word).
HMO CLAIMS
Claim Denials
ezcap
Medicare Claims
CPT Codes
excel
Medicare Guidelines

Responsibilities

performing activities related to benefit analysis and system design
managing special projects
claim denials
auto-adjudication applications, as it pertains to auditing and claims compliance
oversight of all workflow, research, and documentation under limited supervision from Claims management
identifies potential company risks
implements appropriate courses of action
develops strategies to reduce adjudication errors
analyzes all relevant information to track and trend the outcomes of special projects
providing findings to the appropriate management