Apply on Employer Site

Partnership HealthPlan of California · 1 week ago

Claims Auditor I

Sonoma County, CA

Full-time

Onsite

Entry Level

$30.38/hr - $36.46/hr

2+ years exp

Partnership HealthPlan of California is seeking a Claims Auditor I to perform audits on various claim types for their lines of business. The role involves conducting concurrent and retrospective audits, documenting outcomes, and maintaining knowledge of relevant policies and regulations.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Perform concurrent and retro claims audits on new Claims examining staff and on claims processed by existing Claims staff as outlined in Claims Operating Instruction Memorandums for all lines of business

Document audits and report all audit outcomes following the Partnership Claims Operating Instruction Memorandums on claims auditing

Maintain current knowledge of Partnership Claims Policy and Procedures for all lines of business, Medi-Cal Provider Manual, Title 22 regulations, Knox Keene regulations, and CMS Medicare regulations

Perform special claims audits as assigned

Participate in special projects and assignments as required

Other duties as assigned

Qualification

Claims examining experienceMedi-Cal claims processingCPT codingICD-9/ICD10 codingAMISYS claims systemTyping speed 30 wpm10-key calculator proficiencyJudgmentCommunication skillsOrganizational skills

Required

Minimum two (2) years of claims examining experience and completion of Partnership Claims training; or equivalent combination of education the experience

Familiar with Medi-Cal and/or managed care claims processing

Knowledge of CPT, HCPC procedure coding, and ICD -9/ICD10 diagnostic coding

Typing speed 30 wpm and proficient use of 10-key calculator

Familiar with AMISYS or similar claims systems

Understanding of claims examining requirements

Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business

Excellent oral and written communication skills

Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy

Ability to work on multiple tasks within established time frames and sometimes conflicting priorities

Good organizational skills with ability to maintain accurate records and documentation of actions and decisions

Ability to use a computer keyboard

More than 60% of work time is spent in front of a computer monitor

When required, ability to move, carry or lift objects of varying size, weighing up to 5 lbs

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994

Fairfield, California, USA

1001-5000 employees