Claims auditor Jobs in Houston, TX

Job Description

WHAT YOU’LL BE DOING

• Understand and stay current with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations.
• Ensure accuracy of claims processing and contract logic builds through internal audit processes.
• Perform targeted audits of claims processing including, but not limited to, high dollar payments, benefit matrix, interest payments, pre-payment and post-payment audits, and multiple procedure claims.
• Perform quality audits of claims staff, eligibility staff, and system logic.
• Perform audits of new client setup in the claims processing software.
• Run access queries as needed for administrative purposes.
• Other duties and responsibilities as assigned.

Qualifications

WHAT YOU'LL NEED TO HAVE

WOULD LOVE FOR YOU HAVE

Additional Information

The base pay range for this role is between  $ 19.00 to $21.91 per hour, paid bi-weekly

All your information will be kept confidential according to EEO guidelines.

COMPENSATION :

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to : skill set, years of relevant experience, education, location, and licensure / certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here  to confirm your internet connection meets these requirements.