Medicare Claims Auditor
- Employer
- DaVita Medical Group
- Location
- Saint Petersburg, Florida
- Salary
- Open
- Posted
- Jul 10, 2017
- Closes
- Sep 11, 2017
- Ref
- 3013256767#FL--J2CBackfill.1
- Industry
- Accounting
- Category
- Finance
Overview: The Claims Audit Analyst reports to the Manager, HealthClaims Audit & Recovery and reviews medical claims on risk contracts for payment accuracy and recovery.
Essential Functions: Review medical claims on risk contracts for payment accuracy and recovery.
Identify and quantify issues, as well as recommend new audit criteria.
Prepare detailed analyses on payment abnormalities and/or questionable payment practices.
Record all claims contested into the contesting database and update monthly, as required.
Maintain productivity expectations.
Interface with physicians, case managers, Provider Contracting, and Medical Management.
Obtain and review all necessary medical record and billing information data from centers, hospitals, nursing homes, etc.
in line with HIPAA requirements.
Assist with the identification of process improvement opportunities based on claims audit review.
Participate on conference calls with managers/director to provide findings, as required.
Assist with special projects and other duties as assigned.
Education: Minimum: High School diploma or GED Associates degree in related field preferred.
Preferred: CCA, CCS, CPC, COC (formerly CPC-H), or CIC coding certifications Experience: Minimum: 2+ years of experience in claims processing or provider configuration Preferred: Medical audit experience Preferred: Experience with ICD9/10 codes, CPT codes, APC-ASC, DRG coding, provider contracts and/or financial analysis Knowledge, Skills, and Abilities: Knowledge of healthcare reimbursement/delivery.
Knowledge of electronic medical records/billing systems and medical terminology and abbreviations Decision making ability that requires the use of considerable judgement in the analysis of data and the problems/errors resulting from the analysis.
Demonstrated proficiency in MS Excel and Word.
Possess high accuracy, efficiency, and dependability.
Possess strong organizational skills.
Ability to perform multiple tasks Communicate effectively, establish and maintain an effective working relationship within other areas of the organization.
Ability to work in fast paced environment with changing priorities.
DaVita Medical Group is an equal opportunity/affirmative action employer.
As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.
DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.
Essential Functions: Review medical claims on risk contracts for payment accuracy and recovery.
Identify and quantify issues, as well as recommend new audit criteria.
Prepare detailed analyses on payment abnormalities and/or questionable payment practices.
Record all claims contested into the contesting database and update monthly, as required.
Maintain productivity expectations.
Interface with physicians, case managers, Provider Contracting, and Medical Management.
Obtain and review all necessary medical record and billing information data from centers, hospitals, nursing homes, etc.
in line with HIPAA requirements.
Assist with the identification of process improvement opportunities based on claims audit review.
Participate on conference calls with managers/director to provide findings, as required.
Assist with special projects and other duties as assigned.
Education: Minimum: High School diploma or GED Associates degree in related field preferred.
Preferred: CCA, CCS, CPC, COC (formerly CPC-H), or CIC coding certifications Experience: Minimum: 2+ years of experience in claims processing or provider configuration Preferred: Medical audit experience Preferred: Experience with ICD9/10 codes, CPT codes, APC-ASC, DRG coding, provider contracts and/or financial analysis Knowledge, Skills, and Abilities: Knowledge of healthcare reimbursement/delivery.
Knowledge of electronic medical records/billing systems and medical terminology and abbreviations Decision making ability that requires the use of considerable judgement in the analysis of data and the problems/errors resulting from the analysis.
Demonstrated proficiency in MS Excel and Word.
Possess high accuracy, efficiency, and dependability.
Possess strong organizational skills.
Ability to perform multiple tasks Communicate effectively, establish and maintain an effective working relationship within other areas of the organization.
Ability to work in fast paced environment with changing priorities.
DaVita Medical Group is an equal opportunity/affirmative action employer.
As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.
DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.