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Claims Auditor

Req #: 107023
Job Location(s): Brooklyn, NY
Zip Code: 11220
Category: Claims
Agency: Elderplan
Status: Regular Full-Time
Office: Office-based

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?:

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No? You will here! You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals. You take care of our patients, residents and health plan members, and we will take care of the rest!

Benefits include:

  • Sign-on Bonuses OR Student Loan Assistance for clinical staff
  • FREE Online RN to BSN and MSN degree programs!
  • Tuition Reimbursement for all full and part-time staff
  • Dependent Tuition Reimbursement for clinical staff!
  • Generous paid time off
  • Affordable medical, dental and vision coverage for employee and family members
  • Two retirement plans! 403(b) AND Employer Paid Pension
  • Flexible spending
  • And MORE!

Responsibilities:

Reviews claims to ensure they are processed correctly and in a timely manner. Examines pertinent information online and through reports to audit all types of claims. Ensures claims are processed in accordance with provider contracts, member benefits, authorization and regulatory requirements. Completes daily, weekly, and monthly claims reports to summarize findings regarding the number of errors, types of errors, reasons for errors and recommends corrective action.

Qualifications:

A Bachelor's degree is preferred. Three to five years claims experience in a managed care environment is required. Experience with analyzing data files to determine the reason claims are not processed in accordance with expected results is important. Other important skills include: knowledge of ICD-9 and CPT4 Coding and medical terminology, excellent evaluation and reconciliation skills, excellent verbal and written communication skills.

Connect With Us!:

Not ready to apply? Connect with us to learn about upcoming opportunities and events at MJHS.

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