Claims Audit Manager

posted on March 13, 2023

Job Description

Location: Los Angeles, CA

Duration: 6 months


  • 3+ years medical claims auditing experience in HMO or IPA/Medical Group setting required, preferably Medicare claims
  • 5+ years’ experience in examining all types of medical claims, preferably Medicare claims
  • Bachelor’s degree in healthcare management or related field, a plus
  • Experience working with Provider Dispute and Appeals
  • Proficiency in Microsoft Office programs (Excel, Access, Word), intermediate level
  • Experience using claims processing systems (EZCAP preferred)
  • Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-9, ICD-10, DRG, etc.
  • Working knowledge of different claims payment methodologies and claim editing guidelines
  • Familiarity with CMS regulations related to Part C claims
  • Understanding of Division of Financial Responsibility on how they apply to claims processing
  • Knowledge of claims processing requirements which include but not limited to eligibility, HMO benefit structures and coordination of benefits
  • Proven problem-solving skills and ability to translate knowledge to the department
  • Ability to multitask
  • Strong Organizational Skills
  • Attention to Detail
  • Ability to use 10 key
  • #LI-JK1


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