Claims Quality Auditor jobs in New York, NY
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)
Recently Added Claims Quality Auditor jobs
Claims Auditor
- Centers Plan for Healthy Living/Centers Care Solutions
-
Staten Island, NY
FULL_TIME
- Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career.JOB SUMMARY: Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and Management to ensure claims are processed in accordance with Federal, State and CPHL established guidelines and/or policies and procedures. Provides feedback or suggestions to enhance current processes and/or systems; works under general supervision. PRIMARY RESPONSIBILITIES: Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any other regulatory requirements. Follow defined audit processes and keep up to date with departmental changes in conducting quality reviews. Ensure the consistent use of current codes, correct information, documentation and departmental procedures by monitoring their use and identifying any deficiencies. Prepare summaries for management of quality review results, including basic analysis of identified trends. Analyzes audit results to recommend system or procedural changes to increase claim accuracy and/or identify opportunities for workflow enhancements. Evaluates Prospective Payment System (PPS) (e.g. APC, DRG, etc.) grouping and pricing information. Meets individual and departmental standards in regards to quality and productivity. Strong organizational, analytical and writing skills. Excellent verbal and communication skills. Maintain good working relationships within and outside of the department. Provides expertise and assistance relative to provider billing and payment guidelines consistent with CPHL policies and procedures and State or CMS guidelines. Performs other duties and special projects as assigned and directed. EDUCATION AND EXPERIENCE: Education Required: BA/BS degree in a financial field or equivalent healthcare experience Preferred: Type of Experience Required: 2 years of claim processing experience with a Medicaid/Medicare Health Plan. Preferred: Experience in health insurance product environment. Specific Technical Skills Required: Proficiency with MS applications, including but not limited to Word, Excel, Outlook Certifications/Licensure: Required: n/a Knowledge and Skills: Effective presentation skills Excellent verbal and written communication skills Must be able to participate in meetings with all levels of management within the organization Detail oriented, excellent follow up Ability to multi-task in a fast paced environment Must be service oriented, quick learner, team player Appreciation of cultural diversity and sensitivity toward target population Preferred: SCOPE INFORMATION # Direct Reports: n/a PHYSICAL REQUIREMENTS: The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.
- 13 Days Ago
Director of Claims Quality
- MetroPlus Health Plan
-
New York, NY
FULL_TIME
- Director of Claims Quality Job Ref: 97369 Category: Claims Department: CLAIMS Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Hire In Rate: $150,0...
- 4 Days Ago
Claims Quality Control Analyst
- Oscar Health
-
New York, NY
FULL_TIME
- Hi, we're Oscar. We're hiring a Claims Quality Control Analyst to join our Claims Operations team. Oscar is the first health insurance company built around a full stack technology platform and a focus...
- 21 Days Ago
Director of Claims Quality
- The Tandym Group
-
New York, NY
FULL_TIME
- A health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quali...
- 22 Days Ago
Lead Quality Auditor
- New York Blood Center Inc
-
Elmsford, NY
FULL_TIME
- Overview At New York Blood Center, one of the most comprehensive blood centers in the world, our focus is on cultivating excellence by merging cutting-edge innovation with diligent customer service, g...
- 7 Days Ago
Quality Assurance Auditor
- NYPD Civilian Jobs
-
Queens, NY
FULL_TIME
- DEPT OF DESIGN & CONSTRUCTION Full-Time Location QUEENS Exam May Be Required Department SSS/QA/Quality Assurance Salary Range: $74,041.00 – $85,147.00 Job Description Hours: Full- Time- 35 Hours Work ...
- 1 Month Ago
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0 Claims Quality Auditor jobs found in New York, NY area
Quality Assurance Manager - Site Compliance
- EPM Scientific
-
New York, NY
- Title: Manager, Site Compliance About the role: Step into a crucial role within a large medical device company as the Ma...
- 4/19/2024 12:00:00 AM
Quality Assurance Manager
- Jericho Project
-
New York, NY
- Job Description Job Description About Jericho Project Jericho Project is a nationally acclaimed nonprofit ending homeles...
- 4/19/2024 12:00:00 AM
Quality Auditor - Pharmaceutical - Senior
- SQA Services
-
Newark, NJ
- SQA is a leading Quality Assurance and Supply Chain solutions firm. SQA manages Supplier Audit and Supplier Development ...
- 4/18/2024 12:00:00 AM
Member Admin Quality Control Specialist
- Equinox Group
-
New York, NY
- We are looking for a detail-oriented and analytical Proof Auditor to join our team. As a Proof Auditor, you will be resp...
- 4/18/2024 12:00:00 AM
Quality Assurance Auditor
- BAP Pharma
-
Somerset, NJ
- Position: QA Auditor (6 MONTH CONTRACT) This is a remote role, onsite 1-2 times per month(costs will be covered) The rol...
- 4/17/2024 12:00:00 AM
FDA Pharmacovigilance Auditor
- SQA Services
-
New York, NY
- Job Description Job Description Job Description Are you passionate about quality in the life sciences area? Do you want ...
- 4/17/2024 12:00:00 AM
Supplier Quality Engineer 3
- Katalyst HealthCares and Life Sciences
-
Flanders, NJ
- Responsibilities: Lead initiatives to improve quality received from assigned suppliers. Support the qualification of par...
- 4/16/2024 12:00:00 AM
Quality Auditor - Life Sciences
- SQA Services
-
New York, NY
- SQA Services is a leading Quality Assurance and Supply Chain consultancy firm. SQA manages Supplier Audit and Supplier D...
- 4/15/2024 12:00:00 AM
About New York, New York
The City of New York, usually called either New York City (NYC) or simply New York (NY), is the most populous city in the United States. With an estimated 2017 population of 8,622,698 distributed over a land area of about 302.6 square miles (784 km2), New York is also the most densely populated major city in the United States. Located at the southern tip of the state of New York, the city is the center of the New York metropolitan area, the largest metropolitan area in the world by urban landmass and one of the world's most populous megacities, with an estimated 20,320,876 people in its 2017 M...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Auditor jobs
$53,703 to $65,824
New York, New York area prices
were up 1.6% from a year ago
were up 1.6% from a year ago
What does a Claims Quality Auditor do?
Claims Quality Auditor in Bloomington, IN
Evaluates claims activities of other departments and / or companies.
December 05, 2019