Demo

Customer Service Auditor

Diagnostic Clinic Medical Group
Irving, TX Full Time
POSTED ON 1/30/2025
AVAILABLE BEFORE 3/29/2025

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30 years of experience building unique benefit solutions and managing customized health plans.

Job Summary
Perform audits and analysis information to measure corporate performance. Review business area records for the purpose of measuring accuracy of department processes within the WebTPA organization. The information will be used to determine individual and unit accuracy, as well as detecting any trends that may need to be addressed. This function will be closely related to the training function for the purpose of performance.

Essential Functions
The essential functions listed represent the major duties of this role, additional duties may be assigned.

  • Perform audits on randomly selected claims, eligibility files, or calls, as determined by corporate audit procedures (60%)
  • Organize audits to be performed on a regularly scheduled basis for all groups (10%)
  • Review and summarize outcomes of audits with each department and present findings to appropriate management (10%)
  • Maintain audit records (10%)
  • Identify processes that need improvement and coordinate related training needs (5%)
  • Follow up on performance issues to ensure corrective measures have been implemented (5%)
  • Perform additional special audits as requested by management

Qualifications

  • 3 years related work experience in the appropriate department being audited
  • High school diploma or GED
  • Knowledge of CPT and ICD-9 coding required
  • Knowledge of COBRA, HIPAA, pre-existing conditions, and COB required
  • Extensive knowledge of revenue codes, subrogation, reinsurance contracts, and plan design implementation
  • Knowledge of the fields on the HCFA, UB AND DENTAL form.
  • Knowledge of entering Life claims, correspondence and appeal type of claims (data entry) Customized programs for Medical CPT coding

Preferred Qualifications

  • Some college courses and/or a bachelor's degree desired.

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

  • Medical, dental, vision, life and global travel health insurance
  • Income protection benefits: life insurance, Short- and long-term disability programs
  • Leave programs to support personal circumstances.
  • Retirement Savings Plan includes employer contribution and employer match
  • Paid time off, volunteer time off, and 11 holidays
  • Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.


We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.


Diagnostic Clinic Medical Group is an Equal Opportunity Employer - Protected Veteran/Disabled

 

If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

What is the career path for a Customer Service Auditor?

Sign up to receive alerts about other jobs on the Customer Service Auditor career path by checking the boxes next to the positions that interest you.
Income Estimation: 
$41,527 - $53,091
Income Estimation: 
$47,809 - $60,449
Income Estimation: 
$58,812 - $73,278
Income Estimation: 
$65,036 - $83,221
Income Estimation: 
$70,688 - $86,333
Income Estimation: 
$70,688 - $86,333
Income Estimation: 
$80,418 - $105,051
Income Estimation: 
$89,823 - $111,340
Income Estimation: 
$89,823 - $111,340
Income Estimation: 
$114,932 - $144,168
Income Estimation: 
$49,216 - $63,372
Income Estimation: 
$54,723 - $70,654
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Job openings at Diagnostic Clinic Medical Group

Diagnostic Clinic Medical Group
Hired Organization Address Largo, FL Full Time
What Is Your Impact? As a trusted advisor to GuideWell's business partners, the Senior IT Auditor plays a critical role ...
Diagnostic Clinic Medical Group
Hired Organization Address Irving, TX Full Time
Job Summary The Customer Service Representative is responsible for handling inbound customer calls from both providers a...
Diagnostic Clinic Medical Group
Hired Organization Address Irving, TX Full Time
Job Summary The Customer Service Representative is responsible for handling inbound customer calls from both providers a...
Diagnostic Clinic Medical Group
Hired Organization Address Venice, FL Full Time
Job Summary: Retail Member Advisor's primary responsibilities are in the servicing of existing members through issue res...

Not the job you're looking for? Here are some other Customer Service Auditor jobs in the Irving, TX area that may be a better fit.

Customer Service Auditor

Florida Blue, Irving, TX

Customer Service Auditor

Guidewell, Irving, TX

AI Assistant is available now!

Feel free to start your new journey!