Claims Quality Auditor jobs in Colorado

Quality Claims Auditor: This position exists to ensure the integrity of medical payments for the organization through verification of the accuracy of data-entered information and by auditing service related information and invoice adjudication/payment for compliance with contract terms and Department/Regional policy and procedures.
The auditor must be proficient with the medical systems, claims processing and adjudication. The position requires research, problem resolution and specialized knowledge in the areas of benefits, contracts, Medicare, Medicaid, Coordination of Benefits and Third-Party liability, WebStrat, Multiplan, Beechstreet and other pricers.

• Conducts quality assurance audits for all Lines of Business.


• Conducts quality assurance audits for claim adjustments, refunds and provider disputes.


• Performs routine and moderately complex claim audits for payment accuracy in accordance with regulatory standards, and business policies.


• Participates in some special projects/work.


• Participates in the appropriate and approved training classes during year (in accordance with goals).


• Demonstrates awareness of work required at next level and working at that standard.


• Works on problems of moderate scope where analysis of situations and / or data requires review of variety of factors.


• Exercises good judgment within defined procedures and practices to determine appropriate action.


• Builds productive working relationships internally and externally.


• Presents ideas assertively and directly, providing data to support conclusions.


• Adapts ideas and ties them to the needs and goals of others to gain their support and commitment.


• Applies knowledge of internal and external regulatory processing guidelines.