Position Title: Claims Auditor
Reports To: Claims Compliance Supervisor
Summary: Responsible for the overall auditing
of claims staff. Maintain error logs for
staff. Monitor error trends.
Duties and Responsibilities:
Daily auditing of claims for claims staff.
Reporting errors and trends to the supervisor.
Answer claims questions.
At times, process UB92, HCFA1500, EDI and Scanned
claims including reviewing, coding and inputting
data into processing system using standard
policies, procedures and guidelines.
Meeting production standards set for the department.
Alert supervisor of any updates needed.
Trace claims for possible previous payments
Maintain neat and orderly work area with no
Other duties as assigned.
Typical Physical Demands:
High school diploma required. Minimum education
may be waived in lieu of equivalent experience.
Performance Requirements: (Knowledge, skills,
abilities, education, experience)
Must have min 5 yrs exp in medical claims processing
and a Minimum of 2 yrs exp as a medical claims
auditor. Strong processing knowledge of Prof/Hosp
HMO Claims, Medicare / Medi-Cal guidelines,
ICD-9, HCPCS/CPT coding. EZ-CAP systems knowledge
is a plus.