Health Claims Audit Manager
Looking to work at a firm with an unbeatable culture?
Withum is a forward-thinking, technology-driven advisory and accounting firm, helping clients to Be in a Position of StrengthSM in today’s modern business landscape.
Withum empowers clients with innovative tools and solutions to address their accounting, tax and overall business management needs.
Withum is a place where talent thrives. We recruit only the best and brightest people, with a genuine passion for the business.
Withum is seeking an experienced health claims auditor 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 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
- Responsible for scheduling and oversight of claims team (3-5 at any given time)
- Review work of team members and present to engagement partner for their final review
The Type's of People We Look For Have the Following Qualities :
- BS Degree
- Must be qualified at analyzing and interpreting group health insurance contract provisions and reviewing administrative policies and PPO contracts
- Experience supervising staff and working within a team environment
- Must be familiar with HIPAA and ACA compliance standards
- Must have a minimum of 7-10 years of health claims processing experience (internal auditing skills a plus)
- Good computer skills (Microsoft office preferred), excellent communication skills
- Ability to travel
- 2-4 years of managerial experience in health claims processing is a plus
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