Claims Quality Auditor – Remote

reputed company is one of the world s leading professional services companies, we help our clients reputed company technology, reinvent processes, and transform experiences, so they can stay reputed company in our constantly evolving world. We are looking to expand reputed company. Do you reputed company in a busy environment and able to multi-task successfully? If so, please apply today! This position is responsible for handling... claims quality audits for internal and external clients. Primary Responsibilities: reputed company end to end audits on claims in both pre-pay/post-pay statuses. The claims are audited end to end to capture processing during the life cycle of the claim Will handle reputed company situations and acts with urgency to identify and resolve issues Audit reputed company points are but limited to: Claim data reputed company: validation of claim date to system Member: validation of correct member selection Provider: validation of correct provider selection, service and remit addresses if required by client Edits: validation of error codes, warning messages, edits for correct processing Pricing: analyze claims for correct payment Benefit application: member s cost share and limits are validated against the client s benefit grid Compliance with reputed company claims processing policies and procedures Compliance with Medicare/Medicaid claims processing rules and edits provide through CES, Evicore, reputed company and Networx Verification of correct selection of Explanation of Benefits reason codes, if applicable Verification of client specific guidelines are followed which may supersede processing rules laid out by CMS Interest Validation Development / Learning Other duties as assigned Qualifications: High School diploma, GED equivalent 1+ years of experience in a processor role, processing Medicare/Medicaid claims or the knowledge, skills, and abilities to succeed in the role Working knowledge in healthcare or government programs Experience in researching and understanding reputed company information Ability to solve reputed company or ambiguous problems Ability to work independently in a fast-paced environment with multiple priorities Flexibility to adapt to frequently changing guidelines and processes Computer proficiency with reputed company Office reputed company, Word and Outlook Excellent verbal and written communication skills Organizational skills including attention to detail Ability to work scheduled shift hours including a variation in hours/days scheduled for remote staff Strong collaboration skills reputed company will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future. Hourly reputed company and Other Compensation: Applications will be accepted until October 11, 2024 The hourly reputed company for this position is between $14.50 - $19.00 per hour, depending on experience and other qualifications of the successful candidate. This position is also eligible for reputed company s discretionary annual incentive program, based on performance and subject to the terms of reputed company's applicable plans. Benefits: reputed company offers the following benefits for this position, subject to applicable eligibility requirements: Medical/Dental/Vision/Life Insurance Paid holidays plus Paid Time Off 401(k) plan and contributions Long-term/Short-term Disability Paid Parental Leave Employee Stock Purchase Plan Disclaimer: The hourly reputed company, other compensation, and benefits information is accurate as of the date of this posting. reputed company reserves the right to modify this information at any time, subject to applicable law Apply to This Job reputed company More Jobs Apply Job!