Top 32 Claims quality auditor Jobs in Burbank, Ca

Claims Auditor
Imperial Management Administrators Services Inc —Pasadena, CA
- $30 - $35 an hour
- Microsoft Word
- Microsoft Excel
- Writing skills
Quick Apply
Claims Quality Auditor
UCLA Health —Los Angeles, CA
- $31.51 - $62.64 an hour
- Computer literacy
- Research
- Mid-level
Chart Auditor - Glendale
Adventist Health —Glendale, CA
- $62.83 - $86.18 an hour
- Full-time
- Nursing
- RN License
- Mid-level
Claims Auditor, Managed Care (remote)
Cedars-Sinai —Los Angeles, CA
- $27.18 - $42.13 an hour
- 8 hour shift
- Remote
- Mid-level
- High school diploma or GED
- Bachelor's degree
- Health insurance
- Dental insurance
Auditor
Contact Government Services, LLC —Los Angeles, CA
- $50,000 - $100,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Quick Apply
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
Experienced Aerospace Quality Specialist
Align Aerospace LLC —Chatsworth, CA
- $34 - $37 an hour
- Full-time
- Mid-level
- 3 years
- Ability to lift 50 pounds
- Paid training
- Paid holidays
Quick Apply
9d
Manager, Quality Data
L.A. Care Health Plan —Los Angeles, CA
- $117,509 - $188,015 a year
- Full-time
- Microsoft Access
- RN License
- 5 years
- Wellness program
- Health insurance
Experienced Aerospace Quality Specialist
Align Aerospace —Chatsworth, CA
- $34 - $37 an hour
- Full-time
- Mid-level
- 3 years
- Ability to lift 50 pounds
- Paid training
- Paid holidays
Quick Apply
8d
Vehicle Inventory Auditor
CCC Intelligent Solutions Inc. —Los Angeles, CA
- $1,600 a month
- Part-time
- High school diploma or GED
- Driver's License
- Travel
- Paid training
- Mileage reimbursement
Quick Apply
1d
Accounts Receivable Clerk
Nissin Foods (USA) Co., Inc. —Gardena, CA
- $24 - $29 an hour
- Full-time
- ERP systems
- Mid-level
- Office
EDI Administrator
ICW Group —Woodland Hills, CA
- $22.54 - $35.54 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Paid holidays
- Health insurance
9d
Sr. Manager, Quality Assurance and Compliance - Health Plan Operations
SCAN Health Plan —Lakewood, CA
- $125,400 - $181,419 a year
- Full-time
- Hybrid work
- Background check
- 5 years
- Analysis skills
- Wellness program
- Paid holidays
Quick Apply
17h
Senior Manager, Risk Adjustment
Imperial Management Administrators Services Inc —Pasadena, CA
- $100,000 - $150,000 a year
- 5 years
- HIPAA
- English
Quick Apply
Manager, Billing & Audit (KH) - USC Care Medical Group CBO - Full Time 8 Hour Days (Exempt) (Non-Union)
USC —Pasadena, CA
- $95,680 - $158,230 a year
- 8 hour shift
- Customer service
- 5 years
- Office
Coding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
USC —Los Angeles, CA
- $33.00 - $54.02 an hour
- 8 hour shift
- Surgery
- 5 years
- Clinic experience
Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)
UCLA Health —Los Angeles, CA
- $95,400 - $208,300 a year
- Management
- Customer service
- 5 years
IT Specialist (DATAMGT)
US Office of Inspector General —Los Angeles, CA
- $90,968 - $197,200 a year
- Online Application
- Background check
- Pass drug screening
- No experience needed
9d
Accounting Manager
Nissin Foods (USA) Co., Inc. —Gardena, CA
- $115,000 - $145,000 a year
- Full-time
- CPA
- 5 years
- Office

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claims quality auditor jobs near burbank, ca

Claims Auditor

Imperial Management Administrators Services Inc -
Pasadena, CA

Quick Apply

Job Details

$30 - $35 an hour

Qualifications

Microsoft Word
Microsoft Excel
Writing skills
Regulatory compliance in claims processing
English
Medical claims processing software
Health information regulatory compliance
Data interpretation
Centers for Medicare & Medicaid Services (CMS) billing regulations
Clinical confidentiality policies
Medical terminology

Full Job Description

JOB DESCRIPTION

JOB TITLE: Claims Auditor FLSA STATUS: Non-Exempt

DEPARTMENT: Claims Audit

REPORTS TO: Claims Audit Manager / Claims Director

JOB SUMMARY:

The Claims Auditor is responsible for reviewing and auditing claims adjudicated by the system and claims examiners prior to check runs. This role ensures accuracy, identifies errors, verifies compliance with regulatory requirements, and provides recommendations for process and system improvements. The Claims Auditor also supports cross-departmental initiatives to maintain payment integrity and compliance with CMS, Medi-Cal, and commercial guidelines.

ESSENTIAL JOB FUNCTIONS:

Accurately apply Health Plan Benefit Matrices and DOFR (Division of Financial Responsibility) during audits.
Facilitate corrections of claim adjudication errors and recommend process improvements.
Test and audit new releases of Medicare and Medi-Cal Fee Schedules, and provider payment methodologies based on contract agreements.
Maintain a strong understanding of provider contracting arrangements and benefits administration to support accurate and timely claim payments.
Stay current on ICD-10, CPT, HCPCS, Revenue Codes, DRG, and billing procedures for healthcare providers and facilities, as well as Medicare and Medi-Cal reimbursement guidelines.
Test and audit claim payments for accuracy against contract data in E-CAP.
Generate and analyze audit reports to identify adjudication errors, overpayments, and underpayments.
Document audit findings with detailed review process, justification, and conclusions.
Track and analyze errors to identify trends and recommend training or system enhancements.
Provide training and mentoring for new staff to improve accuracy and productivity.
Maintain detailed knowledge of EZ-CAP rules related to claims payment.
Ensure compliance with claim timeliness standards:

Commercial: 45 working days
Medi-Cal: 30 calendar days
Medicare non-contracted: 30 calendar days
Medicare Contracted: 60 calendar days

Collaborate with the Recovery Team on overpayment resolution.
Perform Coordination of Benefits (COB) reviews as applicable.
Support overall business needs of the Claims Department and contribute to team goals.
Consistently meet productivity and quality standards as defined by management.

MARGINAL JOB FUNCTIONS:

Take on special projects as needed.
Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

Continuous Learning:

a. Attend required staff meetings.

b. Participate in relevant training, seminars, and workshops to stay informed and up to date.

Customer Focus:

Maintain client/customer confidentiality and privacy in compliance with HIPAA regulations and IMAS's Standards of Conduct.
Foster effective communication and collaboration with supervisors, co-workers, and other staff members.

Quality/Process Improvement/Safety

a. Report any security, health, or safety issues to the appropriate supervisor as soon as possible.

b. Demonstrate a commitment to safety in all duties performed.

c. Follow established policies, procedures, and comply with all regulatory standards set by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

Minimum 2 years’ experience in complex claims processing and/or auditing in the health insurance industry.
EZ-CAP knowledge strongly preferred.

SKILLS/KNOWLEDGE/ABILITY:

Strong knowledge of healthcare regulations and guidelines (CMS, DMHC, DHS).
Proficiency in claims coding and forms (CCI, CMS-1500, UB-04, CPT, ICD-10, HCPCS).
Familiarity with EZ-CAP or similar claims processing systems.
Proficiency in Microsoft Word and Excel; basic understanding of medical terminology.
Excellent organizational, multitasking, and deadline management skills.
Strong analytical and problem-solving abilities with keen attention to detail.
Ability to exercise sound judgment and work independently or collaboratively.
Strong written and verbal communication skills.
Ability to multitask and effectively solve problems in a fast-paced work environment.
Proficiency in reading, writing, speaking, and understanding English, with the necessary communication skills to provide accurate information to residents and staff.
Ability to follow both written and verbal instructions in English.
Commitment to maintaining appropriate levels of confidentiality and privacy in all interactions.
Professional demeanor and ability to interact courteously with customers, members, and co-workers, both independently and as part of a team.
Ability to effectively manage multiple tasks and adapt to shifting priorities as required.
Strong decision-making and problem-solving skills, with the ability to make appropriate judgments in a timely manner.
Ability to prioritize tasks effectively, ensuring that key items are addressed efficiently.
Self-motivated and capable of taking initiative as a self-starter.
Willingness and ability to understand and comply with all relevant Federal, State, and local regulations.

LICENSURE/CERTIFICATE/TRAINING:

Quick Apply

Refine Your Search

claims quality auditor jobs in burbank, ca

Claims Auditor

Claims Quality Auditor

Chart Auditor - Glendale

Claims Auditor, Managed Care (remote)

Auditor

Facility Outpatient Surgical and Claims Edit Auditor (Remote)

Facility Inpatient Surgical and Claims Edit Auditor

Experienced Aerospace Quality Specialist

Manager, Quality Data

Experienced Aerospace Quality Specialist

Vehicle Inventory Auditor

Accounts Receivable Clerk

EDI Administrator

Sr. Manager, Quality Assurance and Compliance - Health Plan Operations

Senior Manager, Risk Adjustment

Manager, Billing & Audit (KH) - USC Care Medical Group CBO - Full Time 8 Hour Days (Exempt) (Non-Union)

Coding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

IT Specialist (DATAMGT)

Accounting Manager

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