Claims Auditor/Trainer

Healthcare Claims Auditor/Trainer

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Job Summary: The Healthcare Claims Auditor/Trainer is responsible for ensuring the accuracy, compliance, and quality of claims processing across all lines of business. This role performs detailed audits, develops and delivers training programs, and provides operational leadership in the absence of Claims Managers or Supervisors. The position collaborates with internal departments and external providers to maintain high standards of adjudication, customer service, and regulatory compliance.

Benefit Highlights:

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!

About Universal Health Services: One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications and Requirements:

• Minimum 35 years of experience in healthcare claims processing, auditing, or training.
• High school diploma or equivalent required; Associate or Bachelor's degree in healthcare administration, business, or related field preferred.
• Strong knowledge of medical terminology, coding, and regulatory guidelines (HIPAA, CMS).
• Excellent analytical and problem-solving abilities.
• Strong communication and presentation skills for effective training delivery.
• Proficiency in claims processing systems and Microsoft Office Suite.
• Experience with Medicare claims processing and compliance required.
• QNXT system experience highly preferred.

EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.