RanchoCucamongaRecruiter Since 2001
the smart solution for Rancho Cucamonga jobs

Claims Oversight Auditor - Internal

Company: Inland Empire Health Plan
Location: Rancho Cucamonga
Posted on: June 5, 2024

Job Description:

What you can expect!Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience!Under the direction of the Claims Oversight Supervisor, the Internal Claims Oversight Auditor is responsible for ensuring the compliance of IEHPs claims payment system and processes by auditing claim payments using standard principles and State and Federal regulations. The auditors are also responsible for documenting and reporting findings and ensuring appropriate actions have been taken to resolve payment issues with the affected departments within IEHP, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.Major Functions (Duties and Responsibilities)1. Audit internal systems and controls to ensure the claims system is set up correctly and claims are processed in accordance with contractual and regulatory requirements.2. Prepare reports on audit results, identify trends, and implement quality improvement activities for improving business processes.3. Initiate and expand recovery opportunities by working with the Provider Resolution and Recovery department and the Reconciliation and Reporting department to develop standard audits.4. Ensure all payment fee schedules, procedure code files and regulatory bulletins are appropriately implemented and maintained timely.5. Attend and actively participate in meetings with all levels of management to articulate audit findings and resolutions.6. Promote teamwork and maintain effective working relationships with others throughout the organization.Commitment to Quality: The IEHP Team is committed to incorporate IEHPs Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.PerksIEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.Competitive salary.Hybrid schedule.CalPERS retirement.State of the art fitness center on-site.Medical Insurance with Dental and Vision.Life, short-term, and long-term disability optionsCareer advancement opportunities and professional development.Wellness programs that promote a healthy work-life balance.Flexible Spending Account Health Care/ChildcareCalPERS retirement457(b) option with a contribution matchPaid life insurance for employeesPet care insuranceEducation & ExperienceFour (4) years auditing claims in a managed care environment including contract and financial DOFR interpretation.Two years (2) claims processing including Medi-Cal and Medicare.High school diploma or GED required.Key QualificationsYes, must have a valid California Driver's License.Knowledge of Medi-Cal and CMS guidelines for claim payments.Strong analytical and problem-solving skills. Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings. Microsoft Office including being able to manipulate large data sets in Excel files.Excellent oral and written communication skills.Start your journey towards a thriving future with IEHP and apply TODAY!by Jobble

Keywords: Inland Empire Health Plan, Rancho Cucamonga , Claims Oversight Auditor - Internal, Accounting, Auditing , Rancho Cucamonga, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Rancho Cucamonga RSS job feeds