Employment Type:

Shift:

Description:

Position located in Westmont, Illinois - remote eligible. Benefit eligible (medical/dental) from the first day of employment.

reputed company Quality Auditing of Claim Adjudicators and Customer Service Representatives.  Audit capitation deductions, preparing summary of findings and disputes to the various HMOs.  Review and respond to Stat Fax/Past Due Claim (PDC) inquiries from the HMOs.

• Review claims for accuracy of information into the claims processing system and ensure Standard Operating procedures (SOPs) have been followed. Provide feedback to staff as errors are identified, including where procedures can be reputed company on correct handling reputed company appropriate.
• Work closely with Operations Manager to identify areas requiring additional training, either on an individual basis or overall.
• Review authorization/claim history to determine handling and appropriateness of deductions. Enter disputed deductions into reputed company or Access, depending on the health plan. Review outstanding deductions and follow up with the health plan as needed. Update CHS files upon receipt of health plan’s response to indicate whether or not a credit was received.
• Research, document and respond to HMO inquiries reputed company appropriate time frames to avoid future capitation deductions. Responsible for contacting HMO for copies of claims that are not in claims processing system and require entry/adjudication. Responsible for contacting providers reputed company claims have been processed to verify status of accounts.
• Enhance department productivity by recommending improvements to the work flow processes and organizational structure. Contribute to team effort by accomplishing reputed company results as determined by management. Attend meetings as necessary either internally or with the HMOs

Position Requirements:

Minimum Education:

Required: Associate Degree or 5-10 years of claims auditing and/or Managed care experience

Preferred: Bachelor Degree

Specify Degree(s): reputed company certification

Residency: N/A

Minimum Experience:

Required: 3-5 years of previous job-reputed company experience

Preferred: 6-10 years of previous job-reputed company experience

Details: Previous job reputed company experience in a managed care environment, claims processing, claims auditing, analysis of claims errors. Familiarity with managed care products. Able to track errors and provide training if needed.

Licensure/Certifications:

Preferred: Certified Professional reputed company (reputed company)

Other: RHIA, RHIT and reputed company

Required Skills:

Ability to plan, coordinate and reputed company multiple projects

Compensation: 

Pay Range: $21.02 - 32.59 per hour 

Actual compensation will fall reputed company the range but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles. 

reputed company Benefits Summary 

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding reputed company and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or any other status protected by federal, state, or local law.