• Quality Auditor I

    Company: Neighborhood Health Plan of Rhode Island

    Location: Providence, RI

    Date Posted: November 18, 2013

    POSITION TITLE: Quality Auditor I DEPARTMENT: Claims Quality and Audit REPORTS TO: Claims Quality Assurance Team Lead HOURS: 37.5 FLSA: Non-Exempt SALARY GRADE: 11 Overview: To ensure claims submitted to Neighborhood for reimbursement are processed accurately according to Neighborhood’s contractual obligations and applicable regulatory guidelines, the Quality Auditor investigates claims related fraud waste and abuse leads, monitors claims billing patterns and payment accuracy, and provide education to providers and employees regarding proper coding and billing guidelines. Qualifications: Required: - Over 5 years experience in all aspects of physician billing, including Professional and Facility coding. - Minimum of 3 years direct application of coding, billing and reimbursement...

    from Neighborhood Health Plan of Rhode Island