What are the responsibilities and job description for the Claims Auditor position at Teksystems LLC?
Job Description
This is a full-time on-site role for a Claims Auditor.
The Claims Auditor will be responsible for auditing claims, utilizing analytical skills to investigate discrepancies, and auditing medical claims.
- This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC (Department of Managed Health Care), and DHS.
- This position includes the responsibility for routine hospital and professional audits, complex audits on individual or random training, and focused claims to identify exceptions to established claims adjudication requirements for claims processing, payment and procedural accuracy.
- In addition, this position is responsible to assist with eligibility identify (e.g. COB, ESRD) and Letters of Agreements as required.
- To maintain in strict confidence, all member, provider, and Health Plan information to which Claims Auditing Specialist has access.
Apply here, or email resumes to: agrove@teksystems.com
