Health Care Partners ยท 4 days ago
Claims Audit Coordinator
Garden City, NY
Full-time
Onsite
Mid Level
$50K/yr - $60K/yr
3+ years expHealthCare Partners is a health care delivery system providing enhanced quality care to its members, providers, and health plan partners. The Claims Audit Coordinator will be responsible for auditing claims processing activities to ensure compliance with HCP guidelines, focusing on payment and procedural accuracy while identifying trends and recommending process improvements.
Hospital & Health Care
Responsibilities
Perform thorough audits on all processed claims, including adjustments, to ensure compliance with HCP guidelines
Identify and analyze both positive and negative trends through ongoing auditing and internal reporting, proactively recommending corrective actions or process improvements as needed
Generate, review, and analyze data processing reports, making necessary corrections or adjustments to claims data
Investigate and resolve any discrepancies or issues arising from audit results, ensuring timely follow-up and resolution
Assist in the training and development of internal audit staff, sharing expertise and best practices to enhance team performance
Maintain and update the audit database to support departmental evaluations, ensuring accurate records are available for internal and external use
Collaborate with other departments to assist in the preparation of external audits, ensuring compliance with regulatory and organizational standards
Price pharmaceutical drugs using an external database, ensuring claims reflect accurate and up-to-date pricing
Perform other duties as assigned to support departmental and organizational objectives
Qualification
Required
Strong working knowledge of CPT, HCPCS, Revenue, and ICD coding standards
Extensive experience with both professional and hospital claims adjudication processes
In-depth knowledge of CMS claims processing guidelines and Correct Coding Initiative (CCI) standards
Proficient in the use of Microsoft Windows applications, particularly Excel and other data management tools
Strong analytical skills with the ability to detect patterns and anomalies in claims data
Ability to manage multiple tasks effectively in a fast-paced, dynamic work environment
Detail-oriented with a commitment to ensuring high levels of claims processing accuracy
Strong problem-solving skills, with the ability to identify solutions to complex claims issues
Excellent communication skills for cross-departmental collaboration and training
High School Diploma or equivalent required
Minimum of 3 years of experience in claims processing, preferably within a managed care or health plan setting
Experience in auditing claims or working in a quality assurance capacity within a healthcare environment is highly desirable
Preferred
Some college coursework preferred, with a focus on health administration, business, or a related field
Benefits
Bonus Incentive: Up to 5% of base salary
Company
Health Care Partners
The Healthcare Partners' Las Vegas health facilities are outstanding, with high quality care and treatment.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase