Position Title: Claims Auditor
Reports To: Claims Compliance Supervisor
Department: Claims
Summary: Responsible for the overall auditing
of claims staff. Maintain error logs for
staff. Monitor error trends.
Duties and Responsibilities:
•
Daily auditing of claims for claims staff.
•
Reporting errors and trends to the supervisor.
•
Answer claims questions.
•
At times, process UB92, HCFA1500, EDI and Scanned
claims including reviewing, coding and inputting
data into processing system using standard
policies, procedures and guidelines.
•
Meeting production standards set for the department.
•
Alert supervisor of any updates needed.
•
Trace claims for possible previous payments
or denials.
•
Maintain neat and orderly work area with no
backlog.
•
Other duties as assigned.
Typical Physical Demands:
None
Supervision:
N/A
Education:
High school diploma required. Minimum education
may be waived in lieu of equivalent experience.
Performance Requirements: (Knowledge, skills,
abilities, education, experience)
Must have min 5 yrs exp in medical claims processing
and a Minimum of 2 yrs exp as a medical claims
auditor. Strong processing knowledge of Prof/Hosp
HMO Claims, Medicare / Medi-Cal guidelines,
ICD-9, HCPCS/CPT coding. EZ-CAP systems knowledge
is a plus.
Certificates/Licenses: N/A
