This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
Unlock Your Next Career Move: Claims Auditor/Trainer Are you meticulous, compliance-driven, and passionate about streamlining healthcare operations? Robert Half is recruiting for a Claims Auditor/Trainer to ensure claims are processed accurately, meet legal standards, and enhance staff knowledge of benefit requirements and regulations.
Job Responsibility:
Conduct audits of processed claims (paid, pending, denied) to verify accuracy in medical coding (ICD-10, CPT, HCPCS), benefit application, and compliance with California's Knox-Keene Act and Medi-Cal regulations
Develop and deliver training for Claims Examiners, including creation of educational materials on workflows, policy updates, and new technologies
Investigate complex claim issues, provider disputes, and appeals
identify root causes for systemic issues and recommend corrective actions
Track and report statistical data on MSO quality and production
Prepare regular reports for management
Maintain current knowledge of state and federal billing laws (CMS/Medicare) to ensure compliance and readiness for audits
Requirements:
High school diploma, GED or equivalent
Four or more years of medical claims payment experience in an HMO environment
Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS
Understanding of Medicare Guidelines and COB
Knowledge of medical terminology
Experience in benefit determination and claims adjudication
Understanding of detail oriented and facility reimbursement methodologies
Strong organizational skills
Computer proficiency with Microsoft Office
Knowledge of claims adjudication systems (Easy Cap a plus)
Flexibility and adaptability
What we offer:
medical, vision, dental, and life and disability insurance