Job Details

Summary
The Claims & Call Auditor audits processed medical insurance claims and customer service calls to ensure validity, accuracy, and compliance with appropriate policies, procedures, and regulations

Hours: Monday - Friday, 8:00AM-5:00PM

Essential Duties and Responsibilities:

• In accordance with company guidelines, performs random medical audits, target audits, re-audits, etc and audits for claims which are in excess of payment authority limits in assigned audit queues.
• Listen to and view all recorded customer service calls within the MPS call center.
• Ensures compliance with appropriate company policies, procedures, guidelines, and reporting requirements; Federal and state regulations; and timeliness of claims processing.
• Utilize Excel, prepares tracking and trending written audit reports based on findings and communicate audit findings with appropriate leadership, with accuracy, and work with the MPS Call Center Manager/Supervisor/Team Lead and analyze the data for training purposes.
• Identifies patterns, trends, and variances related to claims and calls and provides feedback to their Manager.
• Maintains up-to-date working knowledge on regulatory requirements associated with billing and claims processing, as well as HIPAA guidelines/established Encryption policies and procedures.
• Reviews Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) to determine proper category for benefit code determination.
• Create training materials via PowerPoint, and other multiple media platforms as determined by management.
• Participates in all aspects of the organization’s Compliance Program which may include assigning New Hire and Employee Annual Compliance training.

Health, Dental, Vision, and Life Insurance as well as Paid Time Off and Paid Holidays! 

To Apply: Call 727-712-0607 or email jobs.clearwaterfl@expresspros.com