We partner with brokers across the nation to improve the way people purchase and access healthcare.
Claims Quality Auditor
Location
United States
Posted
39 days ago
Salary
$44.8K - $61.1K / year
Seniority
Mid Level
Job Description
Claims Quality Auditor
Gravie
• Ensure the accurate and correct processing of medical claims based on contractual obligations and regulatory requirements • Conduct pre-payment, post-payment, and auto-adjudication audits for claims • Ensure processing, payment, and financial accuracy of claims • Meticulously track and report audit results • Identify corrections and confirm accuracy of adjustments • Escalate trends and issues for process improvement • Investigate claim issues to improve standard processing guidelines • Participate in cross-functional quality committees • Support testing efforts for claims system upgrades • Participate in client external audits • Process claims and create policies as necessary
Job Requirements
- Bachelor’s Degree or equivalent work experience
- 2 years of experience auditing medical claims for a health insurer or TPA
- Extensive (5 years) medical claims processing background
- Ability to analyze data and recognize trends; use of the 5 Whys to determine the true root cause of an issue
- Core system configuration knowledge
- Ability to articulate findings and defend methodology used to produce findings
- Strong independent decision-making, influencing, and analytical skills
- Excellent communication skills
- Demonstrated success getting results through collaboration
- Previous startup company experience (extra credit)
- Previous Payment Integrity experience (extra credit)
- Coding certification from AAPC or AHIMA (extra credit)
- Familiarity with Javelina claims processing software (extra credit)
Benefits
- Alternative medicine coverage
- Generous PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- 401k program
- Transportation perks
- Education reimbursement
- Paid paw-ternity leave
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