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Auditor, Claims Operations

Remote:

Hybrid

Contract:

Full time

Salary:

50 - 62K yearly

Experience:

Mid-level (2-5 years)

Work from:

Montebello (US)

Offer summary

Qualifications:

HS Diploma or GED required, Minimum of 3 years in Claims Processing, Knowledge of Medi-Cal regulations, Understanding of medical terminology, Familiarity with Managed Care concepts.

Key responsabilities:

Review and audit claims accurately
Identify root cause issues and overpayments
Suggest process improvements to management
Coordinate with Claims Recovery Unit
Assist with Health Plan Audit responses

AltaMed Health Services Corporation Health, Sport, Wellness & Fitness Large https://www.AltaMed.org/

1001 - 5000 Employees

See more AltaMed Health Services Corporation offers

Job description

Your missions

Grow Healthy

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

Job Overview

The Claims Auditor will be responsible for the accurate review and auditing of claims that are adjudicated by the system and the Claims Examiners. The auditor will suggest process improvements to management and act as a resource of information to all staff. The Claims Auditor will identify root cause issues, overpayments, coordinate with the Claims Recovery Unit, and assist with review and responses for Health Plan Audits

Minimum Requirements

1. HS Diploma or GED required.

2. Minimum of 3 years of experience with Claims Processing required.

3. Must be knowledgeable of Medi-Cal regulations.

4. Knowledge of Medicare and Commercial rules and regulations preferred.

5. Knowledge of medical terminology

6. Must have an understanding to read and interpret DOFRs and Contracts.

7. Managed Care concepts.

8. Must have strong organizational and mathematical skills.

Compensation

$26.13 - $32.55 hourly

Compensation Disclaimer

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

Medical, Dental and Vision insurance
403(b) Retirement savings plans with employer matching contributions
Flexible Spending Accounts
Commuter Flexible Spending
Career Advancement & Development opportunities
Paid Time Off & Holidays
Paid CME Days
Malpractice insurance and tail coverage
Tuition Reimbursement Program
Corporate Employee Discounts
Employee Referral Bonus Program
Pet Care Insurance

Job Advertisement & Application Compliance Statement

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.