Quality Assurance Claims Auditor - Rochester

Submission Deadline: Department: Operations Position Summary: Conduct random sample audits of claims for all companies, product lines and types. Audit the Claims Payment Process, CPT-4 and ICD-9-CM coding, including adherence to COB rules and regulations. Liaison with other departments to resolve issues. Conduct preliminary investigations of fraud/questionable billing practices as found on audits or when referred by other areas. Back fills for claims processors if needed. Provide training and documentation for new and current processes, including new hires. During down time, assists in testing and the implementation of new products, contract modifications, existing product modifications and process improvements that meet daily departmental goals. Requirements: * High School Diploma or GED. AAS in Health, Business or related field, preferred. Two years progressive work experience in medical and hospital coding and claims processing. Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology. * Basic knowledge of capitation, risk sharing, physician, hospital and facility provider reimbursement methodologies preferred as well as knowledge of coordination of benefits payment rules/ regulations preferred. Prior auditing experience helpful. * Independent Adjusters License is required. (If not certified when hired or transferred into position, must obtain in the next IAC training class.) Ability to work independently as well as be an effective team member. * Excellent interpersonal as well as verbal and written communication skills. Demonstrated organizational and problem-solving skills. Ability to prioritize multiple assignments with attention to details and deadlines in a high volume environment. * Ability to exercise discretion in handling confidential member information.Basic Excel skills as evidenced by the ability to use workbooks, create simple formulas, insert and delete data, create and edit charts, filter and sort lists, and format data. * Basic Word for Windows skills as evidenced by the ability to produce basic business letters and simple tables and charts as well as check spelling, set tabs, change page orientation, sort, save, open and organize electronic files. Location: Rochester Office, 220 Alexander Street, Rochester, NY 14607 Status: Full Time Type: Non-exempt

Please refer to job code 2587 when responding to this ad.

Category:	Accounting/Banking/Finance/Insurance
	> Auditing      > Claims
Location:	Rochester, NY
County:	Monroe County
ZIP Code:	14602
Pay Rate:	Open
Job Terms:	full time
Company:	Preferred Care
Phone:	email only please
Fax:	email only please