Claims Quality Auditor jobs in New York
Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Claims Quality Auditor jobs
Claims Auditor
- Centers Plan for Healthy Living/Centers Care Solutions
-
Staten Island, NY
FULL_TIME
- Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career.JOB SUMMARY: Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and Management to ensure claims are processed in accordance with Federal, State and CPHL established guidelines and/or policies and procedures. Provides feedback or suggestions to enhance current processes and/or systems; works under general supervision. PRIMARY RESPONSIBILITIES: Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any other regulatory requirements. Follow defined audit processes and keep up to date with departmental changes in conducting quality reviews. Ensure the consistent use of current codes, correct information, documentation and departmental procedures by monitoring their use and identifying any deficiencies. Prepare summaries for management of quality review results, including basic analysis of identified trends. Analyzes audit results to recommend system or procedural changes to increase claim accuracy and/or identify opportunities for workflow enhancements. Evaluates Prospective Payment System (PPS) (e.g. APC, DRG, etc.) grouping and pricing information. Meets individual and departmental standards in regards to quality and productivity. Strong organizational, analytical and writing skills. Excellent verbal and communication skills. Maintain good working relationships within and outside of the department. Provides expertise and assistance relative to provider billing and payment guidelines consistent with CPHL policies and procedures and State or CMS guidelines. Performs other duties and special projects as assigned and directed. EDUCATION AND EXPERIENCE: Education Required: BA/BS degree in a financial field or equivalent healthcare experience Preferred: Type of Experience Required: 2 years of claim processing experience with a Medicaid/Medicare Health Plan. Preferred: Experience in health insurance product environment. Specific Technical Skills Required: Proficiency with MS applications, including but not limited to Word, Excel, Outlook Certifications/Licensure: Required: n/a Knowledge and Skills: Effective presentation skills Excellent verbal and written communication skills Must be able to participate in meetings with all levels of management within the organization Detail oriented, excellent follow up Ability to multi-task in a fast paced environment Must be service oriented, quick learner, team player Appreciation of cultural diversity and sensitivity toward target population Preferred: SCOPE INFORMATION # Direct Reports: n/a PHYSICAL REQUIREMENTS: The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.
- 6 Days Ago
Claims Auditor
- Centers Plan for Healthy Living
-
Staten Island, NY
FULL_TIME
- Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance a...
- 6 Days Ago
Claims Auditor
- Lake Shore Central Schools
-
Angola, NY
FULL_TIME
- This is work involving the application of internal control/fiscal accountability practices in reviewing requests for disbursement or reimbursement of qualifying expenses. On a continuing basis, the em...
- 17 Days Ago
Quality Auditor
- Kraft Heinz
-
Avon, NY
FULL_TIME
- General information All posting locations Avon, New York, United States of America Job Function 07 - Quality Date Published 25-Apr-2024 Ref # R-81907Requirements Description & Requirements The Kraft H...
- 16 Days Ago
Quality Auditor
- Mold-Rite Plastics
-
Plattsburgh, NY
FULL_TIME
- MRP Solutions is a leading manufacturer of rigid plastic packaging products, serving a wide variety of markets across the globe. Founded in 1976, MRP has grown from a handful of injection molding mach...
- 19 Days Ago
Claims QA Auditor
- Centivo
-
Buffalo, NY
FULL_TIME
- We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who strug...
- 14 Days Ago
Claims Quality Auditor jobs at Popular Companies
Quality Auditor
- ResourceMFG
-
Jacksonville, FL
- summary ResourceMFG is now hiring Quality Auditors in Lafayette! Pay and Hours: 2nd Shift: 2:30pm-11pm-$20/hr Job Descri...
- 6/11/2024 12:00:00 AM
Quality Auditor
- Texas Children's Hospital
-
Bellaire, TX
- Job Summary We are searching for a Quality Auditor - Benefits, Contracts, Fee Schedules Configuration/Testing - someone ...
- 6/11/2024 12:00:00 AM
Quality Auditor
- Loma Linda University Health
-
Loma Linda, CA
- Job Description Job Summary: The Quality Auditor will be responsible for auditing departmental workflows and functions, ...
- 6/11/2024 12:00:00 AM
Quality Auditor
- Catalent Pharma Solutions
-
Madison, WI
- **Quality Auditor** **Position Summary:** Catalent is a global, high-growth, public company, and a leading partner for t...
- 6/9/2024 12:00:00 AM
Quality Auditor
- Flextronics
-
Salt Lake City, UT
- Job Posting Start Date 04-26-2024 Job Posting End Date 06-26-2024Flex is the diversified manufacturing partner of choice...
- 6/8/2024 12:00:00 AM
Quality Auditor
- Plastipak Holdings
-
Jackson Center, OH
- As a Plastipak Quality Auditor, you audit systems and processes as they relate to our Quality program. You play a key ro...
- 6/7/2024 12:00:00 AM
Quality Auditor
- Amsted Automotive Group
-
Sterling Heights, MI
- ABOUT THE ROLE Means TransForm Products is now the newest business unit of the Amsted Automotive Group, a premier techno...
- 6/7/2024 12:00:00 AM
Quality Auditor
- Mauser Packaging Solutions
-
York, PA
- JOB DESCRIPTION Responsibilities Performs quality assurance testing as required. Reviews production orders or schedules ...
- 5/23/2024 12:00:00 AM
About New York
New York is a state in the Northeastern United States. New York was one of the original thirteen colonies that formed the United States.
New York covers 54,555 square miles (141,300 km2) and ranks as the 27th largest state by size.[3] The highest elevation in New York is Mount Marcy in the Adirondacks, at 5,344 feet (1,629 meters) above sea level; while the state's lowest point is at sea level, on the Atlantic Ocean.
In contrast with New York City's urban landscape, the vast majority of the state's geographic area is dominated by meadows, forests, rivers, farms, mountains, and lakes. Most of...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Claims Quality Auditor jobs
$49,270 to $60,392
Most Popular Cities in New York for Claims Quality Auditor Jobs
What does a Claims Quality Auditor do?
Claims Quality Auditor in Bloomington, IN
Evaluates claims activities of other departments and / or companies.
December 05, 2019