Medical Records Claims Auditor

KabaFusion•Cerritos, CA

3d•$24 - $28

About The Position

This position is responsible for evaluating, tracking, auditing, and monitoring processes as they relate to billing to assure accurate claims and compliance. KabaFusion is the largest privately held home infusion company in the country, with a national network of pharmacies and nursing offices serving over 40 states. The company has over 30 years of combined experience and is an industry leader in home infusion.

Requirements

High school diploma or equivalent.
Minimum of one (1) year experience in home infusion.
Proficient experience with Microsoft Office including Word, Excel, PowerPoint, Outlook, Teams.
Knowledgeable and understanding of HCPC and CPT codes.
Demonstrate the ability to manage tasks independently, with minimum supervision.
Demonstrate the ability to meet deadlines.
Strong understanding of insurance terms, medical terminology, pricing methodologies for commercial and government billing requirement.

Nice To Haves

CPR+ software system or similar system preferred.

Responsibilities

Acts as a liaison between the reimbursement department and various other departments throughout the organization to audit, monitor, track and resolve reimbursement issues.
Responsible for processing and managing audit requests from payers assuring all required documentation is on file and submitted by the deadline for successful results.
Responsible for identifying and reporting pharmacy document discrepancies and reporting them to Director of Reimbursement or other management team members.
Audits pharmacy online claims for accuracy and correct claim submission for accurate reimbursement.
Assures billing processes are compliant with payer requirement for Government, Commercial Health Plans and Medical Group payers.
Communicates and addresses reimbursement issues with management for resolution in a timely manner.
Responsible for the processing of all internal audits conducted by the board of directors and investors, ensuring effective completion and positive outcomes.
Responsible for responding to and completion of all Subpoenas and Medical Record requests, including working with attorney offices or third-party Document Management companies.
Must be able to prioritize, multi-task, meet goals and deadlines.
Protects patient health information by following regulations for HIPAA compliance.
Other related duties as assigned by manager or designee.