Job: Claims Auditor

SUMMARY
To ensure quality and financial accuracy of processed claims and provide reporting to support audit findings.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Develop and complete financial reports for overpayments, duplicate payments, high dollar claims, patient reimbursements, rolling audits and retro contracts.

Request, track and report overpayment, refunds and voids.

Handle all refunds, voids and reissue of payments as necessary.

Contribute to the overall success and attainment of team goals by assisting with special projects and working overtime when needed.

Exhibit professionalism and perform in a manner that supports the company's emphasis on customer service and operational excellence.

QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Excellent organizational skills.

Knowledge of the CSC system, medical terminology, ICD-9 and CPT-4 coding required.

Experience with Excel reporting required.

Ability to work independently with minimal supervision.

EDUCATION and/or EXPERIENCE

Minimum of one year experience in claims quality review and financial analysis of claims payment.