Claims Auditor

Claims Auditor 26-00030 Alura Workforce Solutions
• Rancho Cucamonga, CA

POSITION
Auditor - Provider Recovery

Position Type: Temporary
Schedule
: M-F, : am - : pm
Assignment Length: Approximately
-Months, possibly longer.

DESCRIPTION

Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims over payments including COB and third-party liability.

Major Functions (Duties and Responsibilities)

. Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
. Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.
. Promote teamwork and maintain effective working relationships with others throughout the organization.

• Four () years claims processing experience including Medicare and Medi-Cal
• Two () years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
• Experience with MS Office applications

Key Qualifications

• Strong analytical and problem-solving skills
• Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings
• Microsoft Office including being able to manipulate large data sets in Excel files
• Excellent oral and written communication skills