Health Claims Audit Supervisor

Health Claims Audit Supervisor

San Ramon, California, United States

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Withum is seeking an experienced health claims audit supervisor possessing in-depth knowledge of group health and disability claims procedures, medical/dental terminology, including CPT, ADA, HCPC and ICDA codes, and a thorough understanding of automated health claims systems as well as manual claims payment systems.

How You'll Spend Your Time:

• Working closely with our clients, and their vendors, to ensure that health, dental, prescription and vision claims are being paid in compliance with regulations and plan documents
• Reviewing client's claims adjudication internal controls policies and procedures
• Completing audit workpapers documenting procedures, findings and conclusions within assigned budgets and deadlines

The Kinds of People We Want to Talk to Have Many of the Following:

• BS Degree
• Must be qualified at analyzing and interpreting group health insurance contract provisions and reviewing administrative policies and PPO contracts
• Experience working within a team environment
• Must be familiar with HIPAA and ACA compliance standards
• Must have a minimum of 3-5 years of health claims processing experience (internal auditing skills a plus)
• Good computer skills (Microsoft office preferred), excellent communication skills
• Ability to travel as needed based on client assignments

The compensation range for this position is $85,000–$110,000. In addition to the base compensation, Withum offers a competitive benefits package and bonus program (for eligible roles) based on individual and firm performance. Final offer amounts are based on multiple factors such as the specific role, hiring location, as well as the individual's skills, experience, and qualifications.

WithumSmith+Brown, PC is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, (including pregnancy), genetic information, marital status, domestic partnership status, familial status, affectional or sexual orientation, gender identity, citizenship status, national origin, disability or handicap, veteran status, weight, height, or any other classification protected by federal, state, or local law.