Claims Auditor (Grade 14)

The Auditor for the Claims Department is responsible for reporting findings on claim payment audits to the Manager of Training and Quality Assurance. This individual tracks trends and identifies training needs within the department. Reviews and reports on accuracy rates within the Claims department and for reporting results on a weekly and monthly basis to Claims Management. Uses audit results to identify areas for improvement and offers management recommendations regarding organizational development (staff training needs, recruitment and retention needs, etc.), claim error reduction, system deficiencies and other issues related to improving the overall efficiency and effectiveness of Network Health's claims processing infrastructure. Requirements

Conducts a daily random sample audit on claims processed the previous day.Manages audits of Claims team members for quality components including adherence to benefit, provider and member setup as well as authorizations.Tracks results and reports to the Manager of Training and Quality Assurance on a weekly and monthly basis.Gives daily error results to designated staff and reviews any rebuttals received within department response time standards.Reports findings to the Director of Claims on a weekly on monthly basis.Works with the Claims Management staff as needed to set up appropriate workflow, change workflow when necessary and reviews and develops policies and procedures related to program needs.Identifies and reports on trends for organizational development (training, recruitment and retention) and system issues.Works with appropriate departments at Network Health to assure select program success and identify program needs. Additional duties

Interacts positively with all Network Health DepartmentsAttends Claims Department staff meetings.Attends other meetings as neededIs responsible for professional and personal development. Attends appropriate meetings and conferences to foster professional and personal development.Shares learned experiences with all members of the Claims Department.Performs other duties as assigned. Qualifications

High school diploma required, Associate's degree preferred2-3 years experience in a claims processing environment preferably processing all types of healthcare claims within a Managed Care Organization. Minimum of 3-4 years of auditing in a healthcare environment required. Excellent written and verbal communication skills. Excellent Interpersonal Skills. Bilingual preferred How to apply

Send your resume with a cover letter to careers@network-health.org . Please include the above Job Code in the subject line of your email. Or, mail them to:

Network Health
Attn: Human Resources
101 Station Landing
Fourth Floor
Medford, MA 02155