Medical Claims Audit AnalystJob ID 85287 Date posted 01/10/2018
- Facility: Sharp HealthCare
- City: San Diego
- Department: PFS Claims Processing
- Category: Business Operations Jobs
- Job Status: Full-Time
- Shift: Day Job
- FTE: 1.0
- Shift Start: 8 AM
- Shift End Time: 4:30 PM
- Knowledge of health insurance or HMO operations with emphasis on claims processing, system set up and auditing software.
- Ability to positively communicate with coworkers.
- Excellent organizational and interpersonal skills.
- Ability to work effectively as a member of a creative management team.
- Excellent understanding of claims adjudication policies and procedures.
- Adept in working with ClaimCheck editing software for accuracy and doing detailed claims reviews.
- Excellent analytical skills and understanding impacts of changes in procedures on accuracy of adjudication.
- A minimum of 5 years in HMO or medical claims auditing.
- Proficient in GE, Microsoft Excel, and Microsoft Word.
- Research skills and experience producing summaries and recommendations.
- Must have strong written and verbal communication skills.
- AAPC Certified Professional Coder (CPC) required.
- Knowledge of word processing and spreadsheet applications is strongly preferred.
- Experience in claims, customer service, and training preferred.