Claims assistant serp_jobs.h1.location_city

Claims Audit Specialist

Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.

Essential Job Duties

• Audits the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing of claims errors.
• Prepares, tracks and provides claims audit findings reports according to established timelines.
• Presents claims audit findings and makes recommendations to leadership for improvements based on audit results.
• Reviews timeliness of claims processing to ensure compliance with contractual and state / federal requirements.
• Maintains minimum claims audit accuracy rate per contractual guidelines.
• Supports claims department initiatives to improve overall claims function efficiency.
• Meets claims audit department quality and production standards.
• Completes basic claims projects as assigned.
• Experience in reviewing high $ claims, claims payment method.

Required Qualifications

Preferred Qualifications

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V