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Title

Claims Auditor  

Description

SUMMARY:

Under supervision of the Chief Executive Officer, the Claims Auditor is responsible for auditing claims and conducting root cause analysis to ensure quality and ongoing compliance. The Claims Auditor will assist with the identification of trends and opportunities for improvement, and will provide appropriate feedback to the Claims Manager.

ESSENTIAL FUNCTIONS:

Auditing

  • Conducts a 5% post-claim, monthly random audit
  • Assists with new-examiner audits
  • Audits claims based on defined criteria
  • Determines if error is statistical, procedural or financial, or related to setup
  • Maintains audit summary report
  • Submits audit results to Claims Manager
  • Distributes audit summary reports to management monthly

Additional Functions

  • Communicates clearly and concisely, with sensitivity to the needs of others
  • Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups
  • Follows all Policies and Procedures and HIPAA regulations
  • Maintains a safe working environment
  • Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
  • Establishes and maintains effective working relationships with co-workers
 
Position Requirements

QUALIFICATIONS:

  • High School Diploma or equivalent
  • Minimum of three years of claims processing experience, required
  • Skilled in use of Windows-based claims processing applications, along with proficiency in Microsoft Word and Excel
  • Skilled in establishing and maintaining effective working relationships with co-workers and clients
  • Detail-oriented with ability to focus on projects for extended periods
  • Ability to work independently, seeking supervision as needed
  • Ability to communicate professionally, clearly and effectively, verbally and in writing
  • Ability to have superior attendance to effectively fulfill all functions of the position
  • Ability to independently follow through on assigned tasks, without prompting
  • Ability to prioritize effectively
  • Ability to consistently multitask

Supervisory Responsibility: None.
Supervised By: Chief Executive Officer
FLSA Status: Non-Exempt

Travel: Minimal travel, less than 10% is expected for this position. For remote positions, travel is required for initial training and for necessary, subsequent training. Travel may also be required for company events.

Expected Hours of Work: This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis.

Normal business hours are typically between 8:00 a.m. to 5:00 p.m.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

  • Required to talk and hear by way of the telephone with participants, customers, vendors and staff
  • Operates a computer and other office machinery such as copy machine, fax machine, office printer.
  • Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy.
  • Frequent, repetitive use of hands/fingers entering information on a keyboard
  • Remains stationary for extended periods of time
  • Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
  • Occasional reaching to retrieve shelved items or bending to access file cabinets

Environment: This job operates in a home office or professional (dress for your day) office environment with a conversational noise level. No substantial exposure to adverse environmental conditions is expected. Moderate pressure to meet scheduled appointments and deadlines. Potential for occasional verbal aggression by clients and vendors.

Tabula Rasa HealthCare, Inc. is an Equal Opportunity Employer.

Employment is contingent upon a successful background/drug check.

 
Full-Time/Part-Time Full-Time  
Shift Days  
Position Claims Auditor  
Post Internal Days 0  
Number of Openings 1  
Location Mediture - Eden Prairie, MN  
About the Organization  
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
Cell None Specified 

HoursPerWk None Specified 

supervisorUID None Specified 


This position is currently not accepting applications.

To search for an open position, please go to http://TabulaRasaHealthcareInc.appone.com



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