Top 8 Claims auditor Jobs in Nashville, Tn

Claims Auditor
American Health Plans —Franklin, TN
- Remote
- Mid-level
- Office
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
13d
Legislative Auditor: TennCare
Tennessee Comptroller of the Treasury —Nashville, TN
- Full-time
- Mid-level
- Office
- Bachelor's degree
- 401(k)
- Flexible schedule
Compliance Auditor
Mental Health Cooperative —Nashville, TN
- Full-time
- Nursing
- Mid-level
- Office
- Health savings account
- AD&D insurance
9d
DRG Auditor (REMOTE)
EnableComp —Franklin, TN
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
Zero Balance Auditor
EnableComp —Franklin, TN
- Full-time
- Remote
- Microsoft Outlook
- Customer service
- Computer literacy
Quick Apply
Royalty Manager - Business Management & Family Office
CITRIN COOPERMAN ADVISORS LLC —Nashville, TN
- $90,000 - $200,000 a year
- Full-time
- Microsoft Access
- 5 years
- Research
Inpatient Coding Auditor
Huron Managed Services LLC —Nashville, TN
- $38.46 - $52.40 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Dental insurance
Quick Apply
11d

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

External Auditor 1
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Or completion of undergraduate core coursework in…
$28.76 an hour
13d
Inpatient Coding Auditor
Huron Managed Services LLC —Columbus, OH
This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours…
$38.46 - $52.40 an hour
Quick Apply
11d

I want to receive the latest job alert for claims auditor in nashville, tn

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

Explore jobs in more locations

claims auditor jobs near nashville, tn

Claims Auditor

American Health Plans -
Franklin, TN

Quick Apply

Job Details

13 days ago

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

claims auditor jobs in nashville, tn

Claims Auditor

Legislative Auditor: TennCare

Compliance Auditor

DRG Auditor (REMOTE)

Zero Balance Auditor

Royalty Manager - Business Management & Family Office

Inpatient Coding Auditor

Explore jobs in cities nearby

I want to receive the latest job alert for claims auditor in nashville, tn

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected