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Claims Auditor

Employer
Health Plan of San Mateo
Location
San Mateo County, California
Salary
Excellent benefits package offered
Closing date
Dec 2, 2019

View more

Category
Claims
Job Type
Not Specified
Career Level
Experienced (Non-Manager)

Job Details

CLAIMS AUDITOR I

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Claims Auditor I to perform concurrent and retrospective review of claims processed by all areas of the Claims Department. Train and/or retrain staff on policies and procedures related to claims processing; and log, track, and report all audit activity and provide information to the Claims Managers and others as required.

The essential duties and responsibilities will include the following: 

  • Perform an appropriate number of audits on a timely basis, based on retrospective accuracy percentages of each incumbent.
  • Perform concurrent, retrospective and preventive review of claims processed by all levels of Examiners, claims processes, and claims transmitted via OCR.
  • Handle responses/appeals to audit findings
  • Assist in the review and maintenance of auditing guidelines, including the audit tracking database and make recommendations to the Claims Managers to increase the accuracy of claims processed
  • Log, track, and report all audit and productivity results and provide information to the Claims Managers and others as needed.
  • Recommend areas in need of additional training and/or close oversight based on the trending and analysis of audit results. 
  • Handle urgent and/or sensitive issues, including PCIs, projects, and escalated calls.
  • Maintain working knowledge of policies and procedures for standard work processes in the Claims Department.
  • Process claims on an occasional basis to maintain skills
  • Perform other duties as assigned

Requirements

Education and Experience: Two (2) years of experience in health claims processing/adjudication. A college degree in a health or business related field is preferred.

Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Medicare and Medi-Cal programs

Ability to: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Adapt to changes in requirements/priorities for daily and specialized tasks. Work in a fast-paced, highly pressured, and changing environment. Analyze/evaluate information. Interpret policies and procedures. Produce basic logs and reports. Interact effectively with others and be a team player. Communicate efficiently orally and in writing. Organize workload. Work independently, using sound judgment

Compensation and Benefits

Starting Compensation Range: - Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage.  Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits.  Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

Company

Why Work at Health Plan of San Mateo

HPSM’s employees are the heart and soul of our organization. Their hard work, dedication and teamwork drive everything we do. HPSM wants employees who will grow with us, so we help employees excel in their current roles while creating career paths for those who want to advance. Maybe that’s why 1 out of 4 HPSM employees have been working here for over 10 years.

Our Mission

We’re a local non-profit County Organized Health System (COHS) dedicated to the health of more than 145,000 low-income San Mateo County residents, from kids to senior citizens. We believe that healthy is for everyone—and we fight to make that possible. We need passionate, caring employees to join our team and our good fight.

A Job That Can Be Your Career

HPSM is looking for employees whose career goals are aligned with our values, and who are looking for a place where they can grow. That’s why we support sustainable workstyles with continual on-the-job learning, training (both on and offsite) and managerial mentoring. The learning, development and advancement opportunities HPSM offers allow you to follow a career track that fits your skills and interests. 

Company info
Website
Telephone
6506162573
Location
801 Gateway Blvd., Suite 100
Oyster Point
South San Francisco
CA
94080
US

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