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Auditor - Provider Recovery

Company: Inland Empire Health Plan
Location: Rancho Cucamonga
Posted on: June 11, 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 Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.Key Responsibilities:1. Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.2. Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.3. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.4. 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; we also aim to match our Team Members with the same energy by providing prime benefits and more.CalPERS retirement457(b) option with a contribution matchGenerous paid time off- vacation, holidays, sickState of the art fitness center on-siteMedical Insurance with Dental and VisionPaid life insurance for employees with additional optionsShort-term, and long-term disability optionsPet care insuranceFlexible Spending Account Health Care/ChildcareWellness programs that promote a healthy work-life balanceCareer advancement opportunities and professional developmentCompetitive salary with annual merit increaseTeam bonus opportunitiesEducation & ExperienceFour (4) years claims processing experience including Medicare and Medi-CalTwo (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretationExperience with MS Office applicationsKey QualificationsStrong analytical and problem-solving skillsMust be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetingsMicrosoft Office including being able to manipulate large data sets in Excel filesExcellent oral and written communication skillsStart your journey towards a thriving future with IEHP and apply TODAY!by Jobble

Keywords: Inland Empire Health Plan, Rancho Cucamonga , Auditor - Provider Recovery, Accounting, Auditing , Rancho Cucamonga, California

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