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Healthcare Claims Auditor

Job ID: 5017322

SalaryApproximate Hours Per Week
42,00040
EmployerDate Posted
The Rawlings Group
LaGrange, Kentucky United States
Aug 02, 2017
Position TypeApplications Accepted Until
Full-timeSep 25, 2017
Description

WHO WE ARE
We pioneered the recovery of healthcare claims in Louisville, KY in the late 1970's and have grown to an organization of 1300 employees that serve our health insurance clients in all 50 states. We have added new clients and are in search of new analysts to conduct research and investigate potential subrogation files.

We offer a unique work environment where you truly can control your own destiny with no limit to earning your monetary goals. We will enable you to achieve your potential and reward you for your efforts. If you thrive in a work environment that allows for independence and offers a variety of challenges, The Rawlings Group may have the career for you.

We are located in LaGrange, KY and provide excellent paid classroom training in a supportive environment to ensure you have all the skills and tools necessary to be successful. We are constantly looking for hard-working, talented people who share our commitment to excellence.

Our comprehensive benefit package includes health and dental benefits, short/long term disability plans, 401K with company matching, a generous vacation policy and more. We also offer an onsite gym, cafe and coffee shop.

The compensation package includes a base pay of $42,000 plus significant bonus potential! Last year experienced Auditors averaged over $70,000!

JOB SUMMARY
The Auditor is responsible for closing the required number of audits per day based upon the audit type with a 100% quality score. The Auditor investigates claims data to identify overpaid/incorrectly paid claims and initiates the recovery of that money for our clients. The position requires extensive online research in clients' claims systems, internal research materials, internet resources and phone communications with members, employers, providers and other insurers. The Auditor is also responsible for handling administrative duties including but not limited to, invoice preparation, invoice follow-up, retractions and file maintenance.

ESSENTIAL DUTIES & RESPONSIBILITIES
- Reviews/audits healthcare claims, and investigates to determine Medicare/Commercial primacy by recognizing and investigating known indicators, and communicating with healthcare providers, employers, members and/or Medicare representatives to gather information to support the primacy determination. Utilizes all available resources to maximize identification and recovery of overpayments, and complies with all company policies/procedures and state and federal laws during the investigation process.
- Answers all phone calls in a timely fashion and resolves issues satisfactorily and in compliance with company policies and procedures.
- Performs administrative tasks required for the invoicing and recovery process.
- Creates and maintains files in accordance with management policies and guidelines by obtaining and attaching all appropriate documentation to clearly identify an audit trail for the audit performed.
- Closes all files in accordance with required coding and approvals according to division guidelines.

The ability to work at our Facility and maintain our regular work schedule of Monday through Friday, 8:00 - 5:00.

OTHER DUTIES & RESPONSIBILITIES
- Communicates with Team Manager and or Assistant Team Manager regarding any training or job knowledge issues, or any other concerns that may arise on the job.
- Seeks to identify process improvements to increase the value of service provided to the client.
- Performs other duties as assigned.

SKILLS & ABILITIES
- Strong analytical skills.
- Possesses excellent skills in verbal and written communication.
- Demonstrated strong organizational skills with proven attention to detail.
- Possesses time management skills; exhibits solid ability to prioritize work and perform multi-tasks.
- Able to work independently without close supervision.
- Spanish/bilingual a plus.
- Must maintain confidential information.
- Demonstrates integrity and honesty in all aspects of job performance.
- Maintains a professional demeanor in all communications.
- Places client service as the number one priority.
- Experience in healthcare/insurance field is helpful, but not required.


PHYSICAL REQUIREMENTS ESSENTIAL TO PERFORM THE DUTIES OF THE JOB
- Frequently remains in sitting position for long periods of time to perform duties.
- Frequently concentrates for long periods of time, paying close attention to detail.
- Frequently uses and views the computer using fingers, hands, and vision.
- Frequently works in a well-lit, tempered environment.
- Frequently communicates by telephone.
- Frequently utilizes mental capabilities to identify, evaluate, and assimilate information.
- Seldom lifts objects with weight up to (twenty-five (25) pounds such as files or paper boxes.


Qualifications
MINIMUM REQUIREMENTS
Associate's Degree (Bachelor's preferred) or equivalent combination of experience in health insurance or related fields, which would provide the necessary knowledge, skills and abilities to successfully perform the work.
Basic computer software experience (Proficient with Microsoft Word, Excel, and Outlook)
Typing speed of at least 30 wpm.

How to Apply
Applying online at: www.rawlingsgroup.com/careers


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