Claims Quality Auditor

Description

Position Purpose: Independently perform comprehensive audits of claims to source documents and identify incorrect payments
 

• Conduct quality audits of claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
• Analyze errors and determine root causes for appropriate classification
• Utilize audit software to provide written documentation regarding audit observations
• Analyze and review responses to audit observations and facilitate corrective action plans
• Monitor state websites and contract changes for impact on claim payments and update audit criteria as necessary
• Assist with special projects

Qualifications

Education/Experience:

• Associate’s degree in related field or equivalent experience. 2+ years of medical or pharmacy claims processing, training or auditing experience.
• Knowledge of claim software systems, Microsoft Office applications, , Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts preferred.
• Knowledge of CPT/HCPCS Coding preferred.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.