Health Claims Audit Supervisor
WithumSmith+Brown•San Ramon, CA
•$85,000 - $110,000•Hybrid
About The Position
Withum is seeking an experienced health claims audit supervisor possessing in-depth knowledge of group health and disability claims procedures, medical/dental terminology, including CPT, ADA, HCPC and ICDA codes, and a thorough understanding of automated health claims systems as well as manual claims payment systems.
Requirements
- BS Degree
- Must be qualified at analyzing and interpreting group health insurance contract provisions and reviewing administrative policies and PPO contracts
- Experience working within a team environment
- Must be familiar with HIPAA and ACA compliance standards
- Must have a minimum of 3-5 years of health claims processing experience (internal auditing skills a plus)
- Good computer skills (Microsoft office preferred), excellent communication skills
- Ability to travel as needed based on client assignments
Nice To Haves
- internal auditing skills a plus
Responsibilities
- Working closely with our clients, and their vendors, to ensure that health, dental, prescription and vision claims are being paid in compliance with regulations and plan documents
- Reviewing client's claims adjudication internal controls policies and procedures
- Completing audit workpapers documenting procedures, findings and conclusions within assigned budgets and deadlines
Benefits
- competitive benefits package
- bonus program (for eligible roles) based on individual and firm performance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
