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Auditor – Claims Operations
| Company | AltaMed Health Services |
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| Location | Montebello, CA, USA |
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| Salary | $26.13 – $32.55 |
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| Type | Full-Time |
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| Degrees | |
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| Experience Level | Mid Level |
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Requirements
- HS Diploma or GED required.
- Minimum of 3 years of experience with Claims Processing required.
- Must be knowledgeable of Medi-Cal regulations.
- Knowledge of Medicare and Commercial rules and regulations preferred.
- Knowledge of medical terminology
- Must have an understanding to read and interpret DOFRs and Contracts.
- Managed Care concepts.
- Must have strong organizational and mathematical skills.
Responsibilities
- Responsible for the accurate review and auditing of claims that are adjudicated by the system and the Claims Examiners.
- Suggest process improvements to management.
- Act as a resource of information to all staff.
- Identify root cause issues and overpayments.
- Coordinate with the Claims Recovery Unit.
- Assist with review and responses for Health Plan Audits.
Preferred Qualifications
- Knowledge of Medicare and Commercial rules and regulations preferred.
