Auditor, Claims Operations

AltaMed

  • Montebello, CA
  • Permanent
  • Full-time
  • 1 month ago
Work Boldly. Live Brilliantly.At AltaMed, we don’t just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challenges because this is more than a job. It’s the calling of our lives and it compels us to keep moving forward.Job OverviewThe Claims Auditor will be responsible for the accurate review and auditing of claims that are adjudicated by the system and the Claims Examiners. The auditor will suggest process improvements to management and act as a resource of information to all staff. The Claims Auditor will identify root cause issues, overpayments, coordinate with the Claims Recovery Unit, and assist with review and responses for Health Plan AuditsMinimum Requirements1. HS Diploma or GED required.2. Minimum of 3 years of experience with Claims Processing required.3. Must be knowledgeable of Medi-cal regulations.4. Knowledge of Medicare and Commercial rules and regulations preferred.5. Knowledge of medical terminology6. Must have an understanding to read and interpret DOFRs and Contracts.7. Managed Care concepts.8. Must have strong organizational and mathematical skills.Benefits & Career Development
  • Medical, Dental and Vision insurance
  • 403(b) Retirement savings plans with employer matching contributions
  • Flexible Spending Accounts
  • Commuter Flexible Spending
  • Career Advancement & Development opportunities
  • Paid Time Off & Holidays
  • Paid CME Days
  • Malpractice insurance and tail coverage
  • Tuition Reimbursement Program
  • Corporate Employee Discounts
  • Employee Referral Bonus Program
  • Pet Care Insurance

AltaMed