Claims Quality Auditor

1 week ago

Upper Hutt, New Zealand Centene Corporation Full time US$19 - US$32

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Independently perform comprehensive audits of claims to source documents and identify incorrect payments.

  • Conduct quality audits of claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
  • Analyze errors and determine root causes for appropriate classification
  • Utilize audit software to provide written documentation regarding audit observations
  • Analyze and review responses to audit observations and facilitate corrective action plans
  • Monitor state websites and contract changes for impact on claim payments and update audit criteria as necessary
  • Assist with special projects
Education/Experience: Associate's degree in related field or equivalent experience. 2+ years of medical or pharmacy claims processing, training or auditing experience. Knowledge of claim software systems, Microsoft Office applications, , Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts preferred. Knowledge of CPT/HCPCS Coding preferred.Pay Range: $ $32.35 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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