Whether you are just starting to think about your career path, or you are an experienced professional looking for your next growth opportunity, you can find a home within the Regal Medical Group family. Join us, and experience the satisfaction that comes from knowing that your job well done makes a true difference in the welfare and health of our members.
The Compliance Auditor is responsible for performing activities related to benefit analysis and system design, and auto-adjudication applications as it applies to auditing co-pay/co-insurance benefits and claims compliance. This includes oversight of all workflow, research and documentation under limited supervision by the Claims management. Identifies potential company risks and implements appropriate courses of action and develop strategies to reduce adjudication errors. Analyzes all relevant information to track and trend to provide findings to appropriate management.
1. Performs routine and complex audits on individual auditing co-pay/co-insurance benefits related to IDM reports daily for accuracy and timeliness.
2. Communicates effectively with all appropriate internal and external individuals, as well as maintain regular contact with the Claims and Benefits management provide audit findings.
3. Utilizes standardized processes, tools, methodologies and presentation templates.
4. Ability to translate health benefit plan design, claims, health related insurance products into systems configuration and identify claim processing problems and errors to determine their origin and appropriate resolution.
5. Notify management immediately if any report processing deadlines cannot be met.
6. Identify, proactively through auditing and internal reporting, negative and positive trends and initiate recommendations for change
7. Analyze data processing reports and make necessary corrections or adjustments.
8. Assist with training of claims adjudication staff as needed.
9. Assist manager with follow-up on any problems or questions related to the audit results
10. Perform other duties as assigned
1. 2 years working knowledge of claims processing and system configuration, preferably EZCap or like systems in the healthcare system.
2. Should exhibit a disciplined, process and data-driven approach and methodology.
3. Knowledge of claims processing and regulatory agencies requirements preferred.
4. Requires strong organizational, communication and written skills.
5. Must be able to function with minimal supervision and be able to prioritize all work tasks.
6. Ability to work well with individuals in all levels of the organization; must be an effective team player.
7. Demonstrated ability to exercise initiative, independent judgment and be a self-starter.
8. 2 years working knowledge of claims processing and system configuration, preferably EZCap or like systems in the healthcare system,
9. Strong PC-based business software skills including MS Office suite (Excel, Word).
Completed applications can be faxed along with your resume to (818) 357-5029, attention Human Resources. Or, you may complete our online application and click the “Submit by Email” button at the end of the application. This will place your application data in a new e-mail addressed to firstname.lastname@example.org using your computer’s e-mail system. You may then attach an electronic copy of your resume to this e-mail and send.