Healthcare Claims Auditor

Description:

Karna is working to staff an immediate opening for a Claims Auditor in support of a CDC (Centers for Disease Control & Prevention)/NIOSH (National Institute for Occupational Safety & Health) contract. This position will offer a qualified candidate a great opportunity to work on a major public health project. If you meet the requirements of this announcement and possess the ability to work in a team environment as well as independently, please apply soon. Position is based in office and temporary to permanent.

Responsibilities:

• Ensure that all claims received are processed accurately and promptly in accordance with program guidelines
• Perform quality audits on claims adjudicated by claims processors and/or team leads
• Reviewing and addressing provider and customer inquiries externally and internally regarding claim adjudication
• Handling escalated, high dollar or complex claims for audit
• Developing and maintaining claims operations policies and procedures in the claims operations manual
• Resolving pended healthcare claims, prior approval requests and responding to providers
• Analyzing claims to determine whether or not the claims should be approved or denied for payment
• Applying knowledge of medical coding and various medical claims forms to the claims process
• Managing daily workflow for a team of processors, including training of new processors and ongoing updated operational processes
• Generating reports and analyzing the data using Microsoft Excel
• Auditing the work of claims processors
• Subject Matter Expert (SME) for claims processing and adjusting within and outside of the claims team

Requirements:

• High School Diploma Required; Associate degree Preferred
• Requires excellent verbal and written communication skills
• Minimum of 5 years claims processing experience
• Must have prior experience working as a Team Lead or auditor
• Experience in a high-volume claims operations environment
• Microsoft Office skills, particularly Excel