Karna, LLC

Improving the Population's Health

Healthcare Claims Auditor

AuditorAuditorFull TimeRemoteTeam 51-200H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

10 days ago

Salary

Not specified

High School5 yrs expEnglish

Job Description

• 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

Job 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

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