Senior Claims Auditor
Company: Partnership HealthPlan of California
Posted on: January 28, 2023
To train all levels of Examiner and Customer Service staff on
related claim processing functions for all lines of business using
Amisys Advance system and Claims Operating Instruction Memorandums.
Performs retrospective, concurrent, and special claims audits on
all claim types for all PHC lines of business. Completes audit
documentation and reports. Provides feedback and recommendations to
the Claims Audit Supervisor and Associate Director of Claims
Technical Support on department audit trends and staff
- Trains all levels of Examiner and Customer Service
- Performs all claims audits.
- Documents audits and reports all audit outcomes.
- Provides feedback and recommendations on staff training needs
and system adjustments.
- Drafts Claims department training documentation.
- Other duties as assigned.
Education and Experience
High school diploma or equivalent; minimum two (2) years of claims
examining experience; or equivalent combination of education and
experience; completion of PHC Claims training preferred; college
course work in business or related field preferred.
Special Skills, Licenses and Certifications
Familiarity with Medi-Cal and/or managed care claims processing.
Knowledge of CPT, HCPC procedure coding, and ICD-9/ICD-10
diagnostic coding. Typing speed 30 wpm and proficient use of 10-key
calculator. Familiarity with AMISYS or similar claims systems.
Understanding of claims examining requirements. Valid California
driver's license and proof of current automobile insurance
compliant with PHC policy are required to operate a vehicle and
travel for company business.
Performance Based Competencies
Excellent oral and written communication skills. Ability to
effectively exercise good judgment within scope of authority and
handle sensitive issues with tact and diplomacy. Ability to work on
multiple tasks within established time frames and sometimes with
conflicting priorities. Good organizational skills with ability to
maintain accurate records and documentation of actions and
Work Environment And Physical Demands
Ability to use a computer keyboard. More than 80% of work time is
spent in front of a computer monitor. When required, ability to
move, carry, or lift objects of varying size, weighing up to 25
All HealthPlan employees are expected to:
- Provide the highest possible level of service to
- Promote teamwork and cooperative effort among
- Maintain safe practices; and
- Abide by the HealthPlan's policies and procedures, as they may
from time to time be updated.
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions,
experience, educational factors and the requirements and conditions
listed in this job description are representative only and not
exhaustive or definitive of the tasks that an employee may be
required to perform. - The employer reserves the right to revise
this job description at any time and to require employees to
perform other tasks as circumstances or conditions of its business,
competitive considerations, or work environment change.
Keywords: Partnership HealthPlan of California, Fairfield , Senior Claims Auditor, Accounting, Auditing , Fairfield, California
Didn't find what you're looking for? Search again!