Claims Auditor

Job Description

Job Description

Care with Heart. Work with Purpose.

Volunteers of America National Services (VOANS) is seeking a (Claims Auditor) to join our PACE team. This is a (remote) role.

This is more than a job! It’s an opportunity to lead claims processes within a mission-driven healthcare organization. In this role , you will maintain integrity and accuracy of the claims processing system across all PACE programs through claims audits and implementation of corrective actions.

Volunteers of America National Services is a subsidiary of the Volunteers of America parent organization. Proudly Great Place to Work® Certified for 8 consecutive years.

Location: Remote
Schedule: M-F 8:00 AM-5:00 PM
Pay Range: $56,000-$65,000

Why You’ll Love It Here

• Opportunity to shape strategy and drive organization-wide impact
• Collaborative executive leadership team that values partnership and accountability
• High-visibility role influencing performance, processes, and outcomes
• Cross-functional collaboration across operations, finance, and clinical teams
• Culture that empowers leaders to innovate, improve, and build strong teams

What We Offer

• Comprehensive Medical, Dental & Vision Insurance
• 403(b) Retirement Plan with Discretionary Employer Contribution
• Generous Paid Time Off (Vacation, Holidays & Sick Leave)
• Life Insurance & Short-Term Disability Coverage
• Employee Assistance Program for personal and professional support
• Wellness Incentives (up to $350 annually)
• Early Pay Access (up to 50% up to $1000 of earned wages)
• Career Development Opportunities

What You Bring (Requirements)

• Education: High School Diploma required; Associate’s degree or higher preferred.
• Experience: 3+ years of experience with medical billing and coding/claims processing or auditing.
• Strong communication and organizational skills
• Ability to analyze, problem-solve, and collaborate effectively with various levels of facility and VOA/VOANS staff and providers.
• Analytical and Organizational abilities.
• Detail oriented with commitment to accuracy and quality.
• Proficiency with claims processing systems and relevant healthcare software preferred.
• Knowledge of CPT, HCPCS, ICD-10, CM and DRG coding.
• Knowledge of HIPAA law and PACE regulations.
• Knowledge of state and federal regulations pertaining to insurance and claims processing
• Ability to examine, evaluate, and adjust claims in accordance with company procedures and state
  regulations.
• Ability to explain complex claims decisions clearly and provide guidance to providers and internal teams.
• Ability to meet the requirements identified and as indicated in the primary job functions.
• Ability to work flexible hours. Minimal to no travel is required.

What You’ll Be Responsible For

• Conduct reviews of claims processes against policy provisions and governing regulations to ensure compliance.
• Conduct claims audits including standard audits and focused audits, to ensure accuracy and integrity of the claims processing system, working with PACE System Administrator on necessary system updates.
• Ensure that claims are processed in compliance with agency and department policies and procedures, contractual agreements, and governing federal and state regulations.
• Respond accurately, timely and professionally to all external and internal communications regarding claims audits, ensuring clarity and accuracy in all interactions.
• Review and work weekly/monthly claims data reports from the claims processing system and maintain productivity goals set forth.
  Review and approve weekly Precheck Registers for all PACE Organizations.
• Ensure all claims appeals are worked timely across all PACE Organizations relevant to governing regulations and contract obligations.
  Assist claims staff and PACE Organization staff in reviewing situations that may warrant focused claims audits.
• Reviews claims for proper billing and processing, including timely submission, compliant coding, required authorizations, and accurate pricing and payment.
• Assist staff on questions and issues related to pricing of claims.
• Maintain accurate and detailed records of all claims audits, including documentation of actions taken, communications with internal staff, and corrective actions implemented.
• Prepare and submit regular reports on claims processing accuracy and trends to the Claims Manager, Director of Health Plan Operations, VP PACE Business Operations, and other relevant stakeholders.
• Maintain knowledge of PACE, CMS, and state Medicaid policies and claims guidelines.
• Develop and implement claims auditing policies and procedures, contributing to the overall effectiveness and accuracy of the claims processing team.
• Communicate to and prepare reports for the Claims Manager, Director of Health Plan Operations, VP PACE Business Operations, and PACE Executive Directors.
• Support various projects from across the PACE Organizations and community-based program enterprise.
• Assist with other duties and projects as assigned.

Volunteers of America National Services (VOANS) is a mission-driven organization dedicated to delivering high-quality healthcare, housing, and supportive services to those in need across the country. We serve seniors, veterans, individuals with disabilities, and families through innovative programs that promote dignity, independence, and well-being. With a strong commitment to compassion, integrity, and service, VOANS operates across multiple healthcare and housing settings nationwide. Our teams are united by a shared purpose, to strengthen communities and make a meaningful difference in the lives of those we serve every day