Auditor

 Audit Medical Claims, including errors from claims pricing, adjudication, adjustments, and bill issues. Conduct periodic post audit of claims to alleviate any incorrect decisions. Maintain a record of audit results Submit errors back to the proper source. Review, research, and resolve complex claims processing issues. Conduct audits of high dollar claims, staff, auditors, regulatory compliance audits, PDR audits and special investigative audits as directed by the manager or supervisor. Working with the claim manager or supervisor to develop procedures ensuring the achievement of goals and will continuously work to improve the quality of work performed within the department. Research complex claims problems and to create clear and concise documentation detailing the handling of complex claims.

Admissions Director