Talent.com

Internal auditor Jobs in Santa ana ca

Last updated: 1 day ago
Claims Auditor

Claims Auditor

Prospect MedicalCA, United States
Full-time
Show moreLast updated: 26 days ago
  • Promoted
Auditor

Auditor

The Pun Group, LLPSanta Ana, CA, United States
Full-time
Show moreLast updated: 1 day ago
  • Promoted
Lead Internal Quality Assurance Auditor, Expat Opportunity in South Korea

Lead Internal Quality Assurance Auditor, Expat Opportunity in South Korea

Laguna SourceCA, United States
Full-time
Show moreLast updated: 30+ days ago
Night Auditor

Night Auditor

HHM HotelsAnaheim, CA, US
$20.00 hourly
Show moreLast updated: 30+ days ago
  • Promoted
Internal Medicine

Internal Medicine

Enterprise Medical RecruitingNewport Beach, California
Full-time
Show moreLast updated: 26 days ago
Internal Auditor

Internal Auditor

LIBERTY Dental PlanTustin, CA
Remote
Full-time
Show moreLast updated: 30+ days ago
  • Promoted
HCC Auditor / Coder

HCC Auditor / Coder

Regal Medical GroupCA, United States
$25.00–$27.00 hourly
Full-time
Show moreLast updated: 3 days ago
Sr. Internal Auditor

Sr. Internal Auditor

E-SolutionsCalifornia, United States
Show moreLast updated: 30+ days ago
  • Promoted
Internal Medicine

Internal Medicine

Provider Solutions & DevelopmentOrange, California
Full-time
Show moreLast updated: 26 days ago
Senior Internal Auditor

Senior Internal Auditor

California Resources CorporationCalifornia, United States
$95,000.00–$115,000.00 yearly
Full-time
Show moreLast updated: 30+ days ago
Claims Auditor

Claims Auditor

Prospect MedicalCA, United States
26 days ago
Job type
  • Full-time
Job description

The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and / or inquiry processing experience to audit and analyze simple to advanced-level claims processing procedures and workflows.

Job Responsibilities / Duties

  • Apply claim processing experience to audit and analyze all levels of claims processing procedures and workflows. Requires the ability to audit claims accurately. Independently run reports on errors identified for potential error trends and report the results to Claims Management and Claims Trainer. Additionally assist in the processing of PDRs , Health Plan Cap Deducts, and claims processing.
  • Handle special projects from external provider and internal departments. Must have the ability to accurately make the necessary adjustments for underpayments and review overpayment requests for Claims Recovery Specialist.
  • Independently audit and analyze high dollar claims and checks prior to the issuance of funds. Must possess the ability to analyze Claims EOB and balance check amounts according to Claims processing guidelines.
  • Analyze and prepare Health plan claims selections for Annual health plan audit. Review samples provider by clerical staff and ensure claims payments are accurate and all documentations required by the health plan auditor is present at the time of audit.
  • Assist the Recovery Specialist in corresponding with external providers regarding Claims Overpayment requests. Requires the ability to communicate and analyze Claims processing methodologies according to CMS and DMHC guidelines.

Qualifications

Minimum Education : High School Diploma or Equivalent. BS / BA preferred.

Minimum Experience : Two to three (2-3) years previous experience as medical claims Auditor or 3-5 years previous experience examining medical Claims preferred. Preferably in an IPA, MSO, or Medical Group setting.

Req. Certification / Licensure : None