Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
POSITION SUMMARY:
This position is responsible for maintaining claims data quality through ongoing quality review and assessment of medical records to ensure appropriate procedures were received. Perform concurrent audits on accuracy of DRG, OPPS, PPS and MPFS payment logic rules. Document findings on reports and identified trends to further evaluate appropriate payment logic is built within the system as well as review post-payment claims that have been identified. Work with the team to help document ways to improve processes for identified risks.
QUALIFICATIONS:
Education, skills and experience:
Clear All
0 Claims Quality Auditor jobs found in Daytona Beach, FL area