Medical Claims Auditor (Healthcare)Long Beach, California Job ID 2001021
Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.
• Helps to evaluate the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.
• Prepares, tracks and provides audit findings reports according to designated timelines.
• Presents audit findings and makes recommendations to management for improvements based on audit results.
• Reviews timeliness of processing to ensure a match to contractual and Federal requirements.
• Maintains a minimum audit accuracy rate per contractual guidelines.
Associate's Degree or equivalent combination of education and experience
Bachelor's Degree or equivalent combination of education and experience
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.