Top 605 External claims auditor Jobs

Claims Auditor- Remote
American Health Plans —Franklin, TN
- Remote
- Mid-level
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
Claims Quality Assurance Auditor
TEXASCONNECT INC —Remote
- Full-time
- Remote
- 5 years
- Word processing
- Writing skills
Facility Outpatient Surgical and Claims Edit Auditor (Remote)
Cedars-Sinai —Los Angeles, CA
- $44.98 - $71.97 an hour
- 8 hour shift
- Remote
- Surgery
- Mid-level
- 3 years
- Dental insurance
- 403(b)
Facility Inpatient Surgical and Claims Edit Auditor
Cedars-Sinai —Los Angeles, CA
- $44.98 - $71.97 an hour
- 8 hour shift
- Remote
- Surgery
- Mid-level
- 3 years
- Dental insurance
- Paid time off
Underwriter/Senior Underwriter
CIS Trust —Wilsonville, OR
- $100,092 - $137,311 a year
- Online Application
- Hybrid work
- Background check
- 5 years
- Public speaking
- Health insurance
- Dental insurance
9d
Finance Manager
Alliance on Aging —Salinas, CA
- $120,000 - $150,000 a year
- Email
- CPA
- Customer service
- Office
- Health savings account
- Health insurance
Quick Apply
8d
PROJECT ACCOUNTANT
Encompass Community Supports —Culpeper, VA
- $66,000 - $82,500 a year
- Full-time
- Microsoft Word
- System design
- Mid-level
- Paid holidays
- Loan repayment program
Capital Expenditure Audit Manager
Stellantis —Auburn Hills, MI
- 7 years
- Management
- Finance
Cash Management Manager
SOAR Partners LLC —Tulsa, OK
- $70,000 - $90,000 a year
- Full-time
- Background check
- Microsoft Excel
- CPA
- Health savings account
- Health insurance
Quick Apply
Staff / Senior Accountant
GoAuto Management Services LLC —Baton Rouge, LA
- Full-time
- Hybrid work
- CPA
- Mid-level
- Office
- Paid holidays
- Disability insurance
Vice President of Finance
O'Reilly Development Company —Springfield, MO
- Full-time
- Background check
- CPA
- Office
- Relocation assistance
- Health insurance
Quick Apply
Staff Accountant
SBLI —Woburn, MA
- $60,000 - $63,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Bachelor of Science
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
11d
Supervisor, Focused Review
Delta Dental of Michigan —Okemos, MI
- Full-time
- Hybrid work
- 5 years
- Word processing
- Research
- Dental insurance
- Opportunities for advancement
Corporate Compliance Manager
SAFE Credit Union —Folsom, CA
- $130,000 - $150,000 a year
- Full-time
- 8 years
- Analysis skills
- Bachelor's degree
- Health savings account
- Health insurance
Dealer Auditor - Pittsburgh
Technology Resource Group —Streetsboro, OH
- Contract
- Dealership
- 5 years
- English
Quick Apply
Controller
Nonprofits' United —Sacramento, CA
- $125,000 - $150,000 a year
- Full-time
- Microsoft Word
- CPA
- Office
- Health insurance
- Dental insurance
Quick Apply
Corporate Controller
Fallon Tribal Development Corporation —Fallon, NV
- $103,948.53 - $112,517.24 a year
- Weekends as needed
- CPA
- Office
- Finance
Quick Apply
Controller
JB Vang —Saint Paul, MN
- $100,000 - $150,000 a year
- Full-time
- CPA
- 5 years
- Office
- Profit sharing
- Paid holidays
Quick Apply
1d
Technical Program Manager
LTM —Bellevue, WA
- $80,000 - $90,000 a year
- Senior level
- Paid parental leave
- Paid holidays
Quick Apply
Clinical Director LCSW *Required*
ICL —Brooklyn, NY
- $115,000.00 - $118,449.97 a year
- Full-time
- Management
- 5 years
- Licensed Clinical Social Worker
- Health savings account
- Health insurance
Quick Apply
10d

I want to receive the latest job alert for external claims auditor

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Claims Auditor- Remote

American Health Plans -
Franklin, TN

Quick Apply

Job Details

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
Referral program

Qualifications

Medicare
Managed care
Managed care organization experience
CMS
Regulatory compliance in claims processing
Medical claims processing software
CMS regulatory compliance
Health insurance knowledge
Medicare regulations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid
Quality audits
Insurance (Financial sectors)
Healthcare claims compliance audits
Audit support
Healthcare coding compliance audits

Full Job Description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com (https://amhealthplans.com/).

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits and Perks include:

Affordable Medical/Dental/Vision insurance options
Generous paid time-off program and paid holidays for full time staff
TeleMedicine 24/7/365 access to doctors
Optional short- and long-term disability plans
Employee Assistance Plan (EAP)
401K retirement accounts
Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
Work assigned claim projects to completion
Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
Maintain production and quality standards as established by management
Participate in and support ad-hoc audits as needed
Other duties as assigned

JOB REQUIREMENTS:

Proficient in processing/auditing claims for Medicare and Medicaid plans
Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
Current experience with both Institutional and Professional claim payments
Knowledge of automated claims processing systems
Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:

Experience:
- Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
- Two (2) years’ experience in managed healthcare environment related to claims processing/audit
- Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
- Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
- Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
License/Certification(s):
- Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Quick Apply

Refine Your Search

external claims auditor jobs

Claims Auditor- Remote

Claims Quality Assurance Auditor

Facility Outpatient Surgical and Claims Edit Auditor (Remote)

Facility Inpatient Surgical and Claims Edit Auditor

Underwriter/Senior Underwriter

Finance Manager

PROJECT ACCOUNTANT

Capital Expenditure Audit Manager

Cash Management Manager

Staff / Senior Accountant

Vice President of Finance

Staff Accountant

Supervisor, Focused Review

Corporate Compliance Manager

Dealer Auditor - Pittsburgh

Controller

Corporate Controller

Controller

Technical Program Manager

Clinical Director LCSW Required

I want to receive the latest job alert for external claims auditor

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected