Supporting a collaborative work environment rooted in knowledge, trust, growth and respect.
Director of Claims Audits
Location
California
Posted
121 days ago
Salary
$90K - $130K / year
Job Description
Job Requirements
- 10+ years or more experience in processing HMO claims in a managed care environment.
- Proficient in Medical Record Review as it pertains to ICD10 coding.
- Proficient in rate application for outpatient PPS & Inpatient DRG facility, ASC, APC, Interim Rate Payment methods to applicable lines of business. (Medicare, Commercial, Medi-Cal).
- Familiar with all regulatory requirements including CMS, DMHC and DHS.
- Proficient with all Federal and state requirements in claim processing.
- Knowledge of medical terminology and coding.
- Recognize the difference between Shared Risk and Full Risk claims.
- Proficient in applying Division of Financial Responsibility.
- Knowledgeable in applying Health Plan Benefit Matrices.
- Proficient understanding of AB1324.
- Proficient understanding of AB1455 Claims Settlement Practice & Dispute and Resolution regulations.
- Excellent communication skills including reports, correspondence, and verbal communications.
- Demonstrated proficiency with Microsoft Word and Excel.
Benefits
- 100% employer paid medical, vision, dental, and life coverage
- Paid holiday
- Sick time
- Vacation time
- 401k plan
- Additional employee paid coverage options available
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