Claims Auditor

Aya Healthcare has an exciting Claims Auditor for a 13 week contract opportunity located in Whittier, CA!

Job Details:

JOB TITLE

Claims Auditor

CONTRACT DURATION

13 week contract with possibility of extending

SHIFT:

M-F 7-3:30pm

ORIENTATION IS M-F FROM 8-5PM FOR THE FIRST 2 WEEKS LOCATION

Whittier, CA

ONBOARDING TIME

Expect 2-3 weeks from offer acceptance to start date.

PAY:

$27.25-30.25hr

DETAILS ABOUT THE INPATIENT CLAIMS AUDITOR

Workers Compensation claims specialist Needs experience in a medical claims payment production environment The Claims Auditor assists in the Claims Department by analyzing procedures, policies and reports; ensures appropriate payment of claims and maintenance of the claims system as necessary.

SPECIFIC SKILLS NEEDED

Knowledge of HMO/or IPA operations; medical terminology; ICD-10, RVS, and CPT coding knowledge; knowledge of Medicare and Medi-Cal guidelines; 10-key skills by touch; excellent communication skills; knowledge of system applications; ability to function effectively under time deadlines; strong organizational skills.

Required:

Formal training will be indicated by a high school diploma or equivalent; four years medical claims processing.

Preferred:

Department Management to list.

DUTIES AND RESPONSIBILITIES 1.

Safeguards and preserves the confidentiality of patient's protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital and departmental policies. 2. Ensures a safe patient environment and adherence to safety practices per policy. 3. With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant other when administering care. 4. Assist the Claims Director in the training and education of the Claims department staff 5. Coordinate the generation and review of claims audit, status and pending claims reports ensuring authorized claims are paid in accordance with company guidelines 6. Investigate, process and track payment adjustments including refunds, overpayments and underpayments 7. Act as a confidential and professional resource for group providers and other staff. 8. Act as a resource for providers, members, insurance carriers, attorneys and co-workers, researching and responding to questions in a timely manner 9. Create, maintain and generate system reports 10. Interface with the Claims Director to ensure claims processing functions meet legal and contractual requirements with regards to health plan audits 11. Prepare and present weekly and monthly reports reflecting staff and departmental quality statistics 12. Review and audit member liability denials and Provider Dispute Resolution claims to ensure compliance with regulatory requirements and passing audit scores from health plans 13. Perform other duties as assigned

TEAMWORK/CUSTOMER SERVICE RESPONSIBILITIES 1.

Customer Service Values and Behaviors:

1.1

Value:

Each person is treated with respect, dignity, fairness and compassion.

Behavior:

Performance is acceptable when everyone is promptly greeted with a smile in a warm and caring manner using the person's name whenever possible. No matter how I feel, I display a caring attitude. 1.2

Value:

Each person displays loyalty and pride in PIH Health and upholds the confidentiality of patients, visitors, physicians, and co-workers.

Behavior:

Performance is acceptable when concerns/problems with fellow employees and customers are not discussed with anyone other than the person involved or the supervisor. Customer issues and ideas are listened to and appropriate follow up occurs to create a satisfied customer. I do not make excuses. I do not demean other people or departments. 1.3

Value:

Each person demonstrates commitment to open communication.

Behavior:

Performance is acceptable when openness and acceptance of constructive criticism occurs. Positive communication occurs by complimenting and expressing appreciation to others. I will listen and encourage others to express ideas and opinions. 1.4

Value:

Each person demonstrates pride in the physical appearance of all PIH Health properties.

Behavior:

Performance is acceptable when the initiative is taken to maintain a clean and safe environment. I conduct myself in a manner which respects and preserves equipment and the physical plant. I do not walk by spills, trash or unsafe conditions without assuring that they are attended to promptly by me or appropriate personnel.

PERSONAL QUALITIES

Department Management to list.

COMMUNICATION

Talking or hearing essential to communicate with patients and staff. Good communication skills; read, speaks and writes English fluently. Bilingual skills in Spanish/Chinese preferred

APPLICATION REQUIREMENTS

• Upcoming requested time off for the duration of the contract.
• Interview availability for the next 7-10 days.
• Resume with last seven years of work history if applicable - all work history gaps of 90+ days must be explained.

AYA DELIVERS

…

• Front-of-the-line access to exclusive jobs at thousands of healthcare facilities nationwide.
• A robust team to support you every step of the way to ensure you start on time, have accurate payroll and an exceptional experience.
• A credentialing specialist to streamline the entire compliance process.
• And of course, you get the usual benefits such as: o Premium medical, dental, vision and life insurance beginning day one of your assignment.

o Pay listed above includes taxable wages and tax-free expense reimbursements, when applicable. Aya Healthcare is an Equal Opportunity Employer and encourages all to apply!

Job Type:

Contract Pay:

$27.25 - $30.25 per hour

Benefits:

Dental insurance Health insurance Vision insurance Application Question(s): Do you have Knowledge of HMO/or IPA operations; medical terminology; ICD-10, RVS, and CPT coding: of Medicare and Medi-Cal guidelines? Do you have experience in a medical claims payment production environment? Are you okay with a 13 week contract with possible extensions? Are you okay with orientation from 8-5pm for the first 2 weeks? Ability to

Commute:

Whittier, CA 90601 (Required)

Work Location:

In person