Auditor - Provider Recovery
This a Full Remote job, the offer is available from: California (USA)
Location: Remote, must reside in Southern CA
Description:
Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.
What You Will Do:
• Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
• Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
• Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.
• Promote teamwork and maintain effective working relationships with others throughout the organization.
You Will Be Successful If:
• Strong analytical and problem-solving skills
• Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings
• Microsoft Office including being able to manipulate large data sets in Excel files
• Excellent oral and written communication skills
What You Will Bring:
• Four (4) years claims processing experience including Medicare and Medi-Cal
• Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
• Experience with MS Office applications
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That’s Impresiv!
This offer from "Impresiv Health" has been enriched by Jobgether.com and got a 78% flex score.
Apply Now
Apply Now
Location: Remote, must reside in Southern CA
Description:
Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.
What You Will Do:
• Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
• Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
• Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.
• Promote teamwork and maintain effective working relationships with others throughout the organization.
You Will Be Successful If:
• Strong analytical and problem-solving skills
• Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings
• Microsoft Office including being able to manipulate large data sets in Excel files
• Excellent oral and written communication skills
What You Will Bring:
• Four (4) years claims processing experience including Medicare and Medi-Cal
• Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
• Experience with MS Office applications
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That’s Impresiv!
This offer from "Impresiv Health" has been enriched by Jobgether.com and got a 78% flex score.
Apply Now
Apply Now