Claims Auditor job vacancy in HealthCare Partners, MSO – Jobs in New York

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Job Details
Company Name : HealthCare Partners, MSO
Company Location : Garden City, NY
Job Position : Claims Auditor
Job Category : Jobs in New York

Job Description :
HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a Claims Assistant in our Garden City Office! :
Position Summary: To audit the claims processing activity for the purpose of assessing individual examiner’s adherence to HCP guidelines in the areas of payment and procedural accuracy. To ensure the accuracy of completed claims prior to payment.
Essential Position Functions/Responsibilities:

Conduct audits on all processed claims, including adjustments.

Identify, proactively through auditing and internal reporting, negative and positive trends and initiate recommendations for change.

Generate and analyze data processing reports and make necessary corrections or adjustments.

Follow-up on any problems or questions related to audit results.

Assist in training of internal audit staff

Maintain audit database for the purpose of departmental evaluation.

Assist with preparation of external audits as needed

Other duties as assigned.

Qualification Requirements:Skills, Knowledge, Abilities

Strong knowledge of CPT, HCPCS, Revenue and ICD coding.

Experienced with professional and hospital claims adjudication.

Knowledge of CMS claims processing guidelines.

Knowledge of Correct Coding guidelines.

Knowledge of Microsoft Windows environment.

Self-starter, willing to take on multiple tasks.

Excellent claims processing accuracy.

Training/Education:

High School Diploma
Some college preferred

Experience:

Minimum of three years claims processing experience preferably in a managed care setting.

HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Job Type: Full-time