Dignity Health

  • Claims Compliance Auditor

    Job ID
    2018-54777
    Employment Type
    Full Time
    Department
    Compliance
    Hours / Pay Period
    80
    Facility
    Dignity Health Management Services Organization
    Shift
    Day
    Location
    Bakersfield
    State/Province
    CA
    Standard Hours
    Mon-Fri (8-5 PM)
    Work Schedule
    8 Hour
  • Overview

    The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

    Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

    Responsibilities

    The Claims Compliance Auditor conducts internal and external delegation oversight audits of  claims including payments, denials and provider disputes. Identifies strengths and deficiencies of claims processing and supporting policies and procedures relative to the quality, accuracy and turn-around-time. 

    Qualifications

    Education & Experience:

    • Three years’ experience as a Claims Examiner or equivalent position (i.e. Appeals Analyst, Claims Adjuster, etc.)
    • Certified coder preferred
    • Requires specialized knowledge in the areas of contracts, Medicare Advantage, Medi-Cal HMO and commercial regulations and reimbursement rules and coordination of benefits  

    Job Skills and Abilities:

     

    • Ability to comprehend detailed information and investigate discrepancies identified through the review of paid claims
    • Good analytical and problem solving skills
    • Ability to quickly assimilate changes in administrative procedures/processes into audit protocols
    • Must have strong knowledge of regulatory requirements governing Medicare Advantage, Medi-Cal, and commercial claims processing
    • Must possess strong verbal and written communication skills
    • Strong sense of individual responsibility and service to the customers and company
    • Must be able to effectively manage multiple priorities
    • Strong computer skills

     

     

     

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