Description and Requirements
The Clinical Claims Auditor examines clinical claims and service authorizations for accuracy and to prevent claim errors. Position reports to the Manager of Clinical Claims Auditing.
Duties/Responsibilities:
- Examines provider claims and service authorizations for completeness, accuracy, and medical necessity and proposes resolutions per internal and regulatory processes.
- Communicates to relevant teams and providers any claims/ authorization inaccuracies found along with recommended solutions.
- Follows up to ensure outstanding issues are resolved and to increase and promote overall satisfaction.
- Compiles recurring issues to help educate teams on error prevention.
- Completes documentation in Patient Health Information database (CCMS) and in accordance with all other company procedures.
- Additional duties as required.
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Minimum Qualifications:
- HS Diploma or GED from an accredited institution.
- experience with Outlook and MS Office.
- Good communication skills.
- Strong attention to detail.
Preferred Qualifications:
- Associate's Degree or Bachelors degree.
- Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese.
- Relevant previous work experience including but not limited to claims, service authorizations, health insurance, and Medicaid managed care products.
- Healthcare industry experience
- Experience working with Claims and Providers.
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400
- All Other Locations (within approved locations): $41,101 - $60,320
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.