• Claims Quality Auditor

    UCLA Health (Los Angeles, CA)


    Description

    Take on a key role within a world-class, award-winning health system. Ensure the efficient delivery of award-winning patient care. Take your career in an exciting new direction. You can do all this and more at UCLA Health.

     

    You will be responsible for monthly random and focus audits of all claim processing activities to identify inaccurate claims adjudication. This will involve reviewing UB04 and CMS 1500 healthcare claims and adjustments for accuracy, and appropriate application claims adjudication, including CMS regulations, Department of Financial Responsibility provisions, Medicare Advantage Plan requirements, policies and procedures, and internal operations guidelines. You will also compile and maintain statistical data and ensure compliance with production and quality standards in accordance with department policy.

     

    Salary Range: $31.51 - $62.64/hourly

    Qualifications

    We're seeking a self-motivated, detail-oriented, deadline-driven individual with:

    * Bachelor's degree and/or equivalent experience

    * Five or more years of medical claims payment experience in Medicare Advantage or combination of equivalent years of education, training and experience

    * Expertise in industry-standard claims adjudication policies, procedures, and processes

    * Knowledge of fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary, professional claims, and Medicare fee schedules

    * Understanding of CPT, HCPCS, ICD-10, ASA, Revenue Codes

    * Experience researching and resolving provider dispute resolutions, adjustments, appeals, and reopen guidelines

    * Understanding of Claim Adjustment Reasons and Remittance Advice Remark codes

    * Knowledge of medical terminology

    * Ability to accurately key between 6,000 and 8,000 keystrokes or type 40 - 50 WPM

    * Strong analytical, mathematical, organizational, and problem-solving skills

    * Computer proficiency with Microsoft Word and Excel

    * Knowledge of claims adjudication systems (e.g., EPIC-Tapestry, QNXT, IDX Facets)

    * Willingness to learn new technologies, practices, and procedures

     

    UCLA Health is a world-renowned health system with four award-winning hospitals and more than 260 community clinics throughout Southern California. We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles' trusted provider of exceptional, compassionate patient care. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.

     

    UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.