The Affinity Medical Solutions Operating Division (AMS) of University HealthCare Alliance in Richmond, CA, has a new opportunity for a Claims Auditor/Trainer. University HealthCare Alliance is a medical foundation affiliated with Stanford Hospital & Clinics.
The Claims Auditor/Trainer performs routine and complex audits to identify inaccurate claims adjudication. This activity includes daily production and audit of focused reports to include, tracking, researching and documenting audit findings, and determining origin and appropriate resolution. The Auditor is accountable for pre-auditing claims selected for health plan audits, and summarizing findings and recommendations for feedback to Claims Examiners and Management. He/she is responsible for reviewing claims audit results with the Director of Claims and Claims Supervisor to improve processing accuracy; providing initial claims processing training to Claims Examiners, and incorporating qualified data into training programs, policies and procedures.
The ideal candidate will be a high school graduate, have seven (7) years’ experience in claims processing in an IPA or HMO related setting, claims training and auditing. The candidate should have thorough knowledge and working experience with ICD-9, CPT and HCPC coding systems, medical terminology, enrollment and membership activities and claim processing procedures/systems. Requires basic proficiency with Microsoft Word and Excel applications.
Please submit your resume and cover letter.
Equal Opportunity Employer