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EI
E-Solutions Inc.
Non-Clinical - Health and Information Management - Auditor
Career Insights for Auditor (General)
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Scorecard
Based on California data
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What they do
An Auditor examines records to determine the financial status of a company or organization. Inspects accounts and account books, prepares reports on the accuracy of internal financial records and accounting procedures.
$79,890 / year median in California
-8% projected decline
Job Description
Other Service Line - BPO TeamLead Operations - OPTLOP (Phoenix, AZ, 85003) | 06/17/25
Job Description Job Description:
MAX VENDOR RATE
$23.50
REMOTE Job Title:
Provider Specialist 14 positions Responsible for reviewing and resolving provider disputes and communicating resolution to provider in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.Job Responsibilities:
- Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina providers and related outside agencies to ensure that internal and/or regulatory timelines are met.
- Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.
- Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines.
- Responsible for contacting the member/provider through written and verbal communication.
- Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested.
- Composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements.
- Research claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
- Resolves and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from outside agencies