Temporary Auditor - Provider Recovery
This a Full Remote job, the offer is available from: California (USA)
Title: Temporary Auditor - Provider Recovery
Assignment Length: Six Months
WORK LOCATION: 10801 6th St STE 120, Rancho Cucamonga, CA 91730
Position Summary/Position
ā¢ 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.
Major Functions (Duties and Responsibilities)
ā¢ Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
ā¢ Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
ā¢ 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.
ā¢ Promote teamwork and maintain effective working relationships with others throughout the organization.
Education & Experience
ā¢ Four (4) years claims processing experience including Medicare and Medi-Cal
ā¢ Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
ā¢ Experience with MS Office applications
Key Qualifications
ā¢ Strong analytical and problem-solving skills
ā¢ Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings
ā¢ Microsoft Office including being able to manipulate large data sets in Excel files
ā¢ Excellent oral and written communication skills
This offer from "LanceSoft, Inc." has been enriched by Jobgether.com and got a 72% flex score.
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Title: Temporary Auditor - Provider Recovery
Assignment Length: Six Months
WORK LOCATION: 10801 6th St STE 120, Rancho Cucamonga, CA 91730
Position Summary/Position
ā¢ 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.
Major Functions (Duties and Responsibilities)
ā¢ Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
ā¢ Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
ā¢ 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.
ā¢ Promote teamwork and maintain effective working relationships with others throughout the organization.
Education & Experience
ā¢ Four (4) years claims processing experience including Medicare and Medi-Cal
ā¢ Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
ā¢ Experience with MS Office applications
Key Qualifications
ā¢ Strong analytical and problem-solving skills
ā¢ Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings
ā¢ Microsoft Office including being able to manipulate large data sets in Excel files
ā¢ Excellent oral and written communication skills
This offer from "LanceSoft, Inc." has been enriched by Jobgether.com and got a 72% flex score.
Apply tot his job
Apply To this Job