Data Entry Claims Auditor (11914)

Globe Life And Accident Insurance Company - McKinney, TX (30+ days ago)3.3


Job Summary
The Data Entry Auditor is primarily responsible for the timely and compliant audit of claims adjudicated by Data Entry (DE) Operators to determine compliance within established policies and procedures. This position will also maintain daily audit reports and update provider files with information submitted on claim forms. The incumbent will serve in a backup capacity for other duties on the Audit team, as needed.

Required Skills:
Primary Duties & Responsibilities
Audit claims adjudicated by DE Operators to ensure accuracy of information keyed into system against submitted claim documents
Review claims for possible duplicates to route to appropriate Key From Image (KFI) queues for timely processing
Prepare audit reports to thoroughly document audit findings and track remediation of errors
Provide timely feedback to DE leadership team regarding identified trends
Assist Medicare Claim Examiners in locating non-indexed claims in Onbase workflow
Maintain records of check pulls to include signature of requestor, reason for pull, and action taken
Review Onbase claim check reports for daily reconciliation of ledger
Add/Update provider files with NPI, TIN, name and/or address as submitted on claim forms
Collaborate with peers and management to improve processes and department work quality
Meet and/or exceed established standards for productivity and quality
Concurrently access multiple databases, software programs, and/or online tools to perform required job functions
Attend and actively participate in departmental meetings, trainings, and coaching sessions
Support and participate in all mandatory compliance trainings
Maintain patient privacy and confidentiality in accordance with HIPAA standards
Perform additional duties as assigned

Required Experience:
Knowledge, Skills, & Abilities
Knowledge of ICD-9/ICD-10, CPT coding, and medical terminology
Proficiency in Microsoft Office Suite (i.e. Outlook, Excel, Word) and other basic computer programs
Ability to multi task with detail-oriented approach to work
Excellent written and verbal communication skills
Strong analytical skills and problem solving capabilities
Ability to meet stringent deadlines
Ability to thrive in fast paced environment while working independently and with limited supervision
Associate's Degree preferred or High School Diploma with equivalent work experience
Experience in interpreting Medicare policy language and processing Medicare claims, a plus
Ability to work within a production environment
Education & Work Experience required
Associate's Degree preferred or High School Diploma with equivalent work experience
Experience in interpreting Medicare policy language and processing Medicare claims, a plus