• Claims Auditor

    Job Locations US-NY-Brooklyn
    Req #
    107023
    Agency
    Elderplan
    Status
    Regular Full-Time
    Location : Postal Code
    11220
    Category
    Claims
    Office or Field
    Office-based
  • Overview

    The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

    Responsibilities

    Reviews claims to ensure they are processed correctly and in a timely manner. Examines pertinent information online and through reports to audit all types of claims. Ensures claims are processed in accordance with provider contracts, member benefits, authorization and regulatory requirements. Completes daily, weekly, and monthly claims reports to summarize findings regarding the number of errors, types of errors, reasons for errors and recommends corrective action.

    Qualifications

    A Bachelor's degree is preferred. Three to five years claims experience in a managed care environment is required. Experience with analyzing data files to determine the reason claims are not processed in accordance with expected results is important. Other important skills include: knowledge of ICD-9 and CPT4 Coding and medical terminology, excellent evaluation and reconciliation skills, excellent verbal and written communication skills.

    Benefits

    We truly value our staff and further acknowledge their contributions by offering:

    • Employee and family health coverage
    • Competitive salaries
    • Employer contributed pension plan
    • Generous time off
    • Tuition reimbursement
    • 403(b) retirement plan

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