CLAIMS AUDITOR

Location & Benefits Position located in Westmont, Illinois - remote eligible. Benefit eligible (medical/dental) from the first day of employment. Perform 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 entered into the claims processing system and ensure SOPs have been followed. Provide feedback to staff as errors are identified. Work closely with Operations Manager to identify areas requiring additional training, either individually or overall. Review authorization/claim history to determine handling and appropriateness of deductions. Enter disputed deductions into Excel 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 within appropriate time frames to avoid future capitation deductions. Contact HMO for copies of claims not in the system that require entry/adjudication. Contact providers when claims have been processed to verify status of accounts. Enhance department productivity by recommending improvements to workflow processes and organizational structure. Contribute to team effort by accomplishing related results as determined by management. Attend meetings as necessary internally or with the HMOs. Employment Type Full time Shift Day Shift Position Requirements Education: Associate Degree or 5-10 years of claims auditing and/or managed care experience; optional Bachelor Degree preferred. AAPC certification or other credential (RHIA, RHIT, AAPC). Minimum 3-5 years of previous job-related experience; 6-10 years preferred. Experience in a managed care environment, claims processing, claims auditing, and analysis of claims errors. Familiarity with managed care products; ability to track errors and provide training as needed. Preferred certification: Certified Professional Coder (AAPC). Compensation Pay Range: $21.02 - 32.59 per hour Equal Opportunity 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 common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. #J-18808-Ljbffr

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