American Health Partners · 2 days ago
Claims Auditor
Franklin, TN
Full-time
Hybrid
Entry, Mid Level
2+ years expAmerican Health Partners is a company that operates Institutional Special Needs Plans for seniors in long-term care facilities. The Claims Auditor will conduct audits to ensure accurate claims payments and compliance with regulations while providing high-quality customer service.
Elder CareHealth CareHome Health CareNursing and Residential Care
Responsibilities
Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
Work assigned claim projects to completion
Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
Maintain production and quality standards as established by management
Participate in and support ad-hoc audits as needed
Other duties as assigned
Qualification
Required
Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
Two (2) years' experience in managed healthcare environment related to claims processing/audit
Two (2) years' experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
Two (2) years' experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
Two (2) years' experience processing/auditing claims for Medicare and Medicaid plans
Proficient in processing/auditing claims for Medicare and Medicaid plans
Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
Current experience with both Institutional and Professional claim payments
Knowledge of automated claims processing systems
Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office
Preferred
Coding certification preferred
Benefits
Affordable Medical/Dental/Vision insurance options
Generous paid time-off program and paid holidays for full time staff
TeleMedicine 24/7/365 access to doctors
Optional short- and long-term disability plans
Employee Assistance Plan (EAP)
401K retirement accounts
Employee Referral Bonus Program
Company
American Health Partners
American Health Partners provides home health care, senior living, and rehabilitation services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Jeff Bogle
CFO
Recent News
Modern Healthcare
2024-10-30
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