Claims Audit Manager

Location: Los Angeles, CA

Duration: 6 months

Responsibilities: 

• 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