Claims Compliance Auditor I

Description

Under the supervision of the Division Manager, the Claims Compliance Auditor must have a minimum of six months experience at Wittman Enterprises. They will have working knowledge of all insurance payors including managed care plans. Proficient in all other software systems utilized to manage work. Must have written and oral skills. Must be able to maintain mail, workflows, and other duties as assigned by the Management staff. 

Work Schedule

This position has a work schedule of five days and 40 hours/week. Duties are performed 12 months a year. May be required to work overtime as needed.

Role and Responsibilities

· Maintain all incoming denials and correspondence from insurance companies. 

· Monitor and provide feedback on the status of denials received from insurance companies. 

· Report any unusual denials that may affect or delay revenue.

· Take insurance incoming calls

· Follow-up on static claims 

· Functional knowledge of the Billing system.

· Maintain working knowledge of Insurance rules/regulations to ensure accurate and timely billing and payment of claims.

· Maintain interface with all Payors on matters relating to billing issues, including telephone contact and correspondence.

· Interact with Division Manger as well as other Managerial staff.

· Adhere to all company policies and procedures. 

· Perform other duties as assigned.

Requirements

Be proficient in word processing and spreadsheet software. Demonstrate ability to be objective, pro-active, assertive, and diplomatic to effectively interact with all departments. Knowledge and experience with Medicare, Medicaid, private insurance plans, Champus/TriCare, Workers Compensation, and other third party payers. Have general knowledge of condition codes, ICD9, CPT, and HCPCS codes. Have knowledge of medical terminology and regulatory compliance requirements. 

Preferred Skills

Typing a minimum of 35 WPM

Flexibility

Customer Service

Dependability

Problem Solver

Communication skills

Detail oriented

Multi-tasking

Self- Motivator

Ability and willingness to accept change

Follow direction

Productivity of (60 to 80 per day)

General working knowledge of PCs and/or patient accounting computer system.