Clinical Claims Auditor

The Clinical Claims Auditor examines clinical claims and service authorizations for accuracy and to prevent claim errors. Position reports to the Manager of Clinical Claims Auditing.

Duties/Responsibilities:

• Examines provider claims and service authorizations for completeness, accuracy, and medical necessity and proposes resolutions per internal and regulatory processes.
• Communicates to relevant teams and providers any claims/ authorization inaccuracies found along with recommended solutions.
• Follows up to ensure outstanding issues are resolved and to increase and promote overall satisfaction.
• Compiles recurring issues to help educate teams on error prevention.
• Completes documentation in Patient Health Information database (CCMS) and in accordance with all other company procedures. 
• Additional duties as required.

Minimum Qualifications: 

• HS Diploma or GED from an accredited institution.
• experience with Outlook and MS Office.
• Good communication skills.
• Strong attention to detail.

 Preferred Qualifications: 

• Associate's Degree or Bachelors degree.
• Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese.
• Relevant previous work experience including but not limited to claims, service authorizations, health insurance, and Medicaid managed care products.
• Healthcare industry experience
• Experience working with Claims and Providers.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400

• All Other Locations (within approved locations): $41,101 - $60,320

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.