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Claims Auditor

Company: P3 Health Partners
Location: Henderson
Posted on: November 20, 2022

Job Description:

Leverage Your Extensive Claims Experience to Make an Impact at a Rapidly Growing Industry Innovator Your Efforts Will Impact Performance, Quality and Financials, and Help Us Meet Our Mission If you combine substantial experience in medical claims, including professional and facility claims payment and provider appeals processing, with deep knowledge of medical benefits adjudication and a communicative, service-oriented approach, the role of Claims Auditor with P3 Health Partners offers you some great advantages. You will: Make a difference -by owning an influential, -senior-level claims role - that directly impacts quality, performance and financials.
Leverage the breadth of your skills - while showcasing -your potential. -We promote from within whenever possible, From this role, you could step into another claims role, such as recovery analyst, follow a different path, such as moving to configuration, pursue a supervisor position, etc. -Our ongoing strong growth will continue to create opportunities for proven performers.
Own a remote -role -working core pacific standard time (PST) hours with -some flexibility , such as choosing a start time between 7 AM and 9 AM, and light travel to the Las Vegas, Nevada area -(less than 10%)
Earn a - competitive salary, bonus potential -and - comprehensive benefits -at a company that celebrates diversity and rewards accomplishments. You'll also have ample overtime opportunities .
Become part of an organization with a - positive, values-driven culture -that's collaborative and respects every employee's unique contributions. People like working here, as demonstrated by the number of long-tenured employees.
Support our mission to be the best health partner for patients, providers and payors -- we are driven to transform healthcare.
We have multiple claims auditor positions available, so feel free to share this information with your network of qualified peers. The Job As Claims Auditor, your primary responsibility will be to audit professional and facility claims for accurate processing per all contract, health plan, and state and federal regulations within payment compliance time limits. You will also be responsible for analyzing and processing provider claim appeals, and for quality and continuous improvements within the scope of your job. You'll audit claims and a specified number of customer service calls, providing feedback and meeting metrics. Your Qualifications To be a good fit for the Claims Auditor role, you will have: Extensive experience (typically 8+ years) in the Medical Claims payment industry, specializing in professional and facility claims payment and processing provider appeals
Must have a strong understanding of local, state and federal rules regarding the adjudication of medical benefits
Strong PC computer skills and experience including MS Office tools (Word, Excel, Teams, -Outlook) and claims management software
Working knowledge of HMO operations, claims delegation compliance, and contract interpretation
Strong knowledge of CPT, HCPCS, ICD-10, DRG and APC coding and CMS guidelines
Must have a combination of excellent analytical and interpersonal communication skills to work with multiple stakeholders and provide feedback in a positive manner
Ability to travel (less than 10%) to Nevada for training and/or -team meetings. Typically, travel will be between 2 and 5 days, 2 to 3 times per year
High school diploma or GED equivalent; some college preferred
Legal authorization to work permanently in the U.S.
Driven by people, with passion and purpose -- That's the power of P3. P3 Health Partners is a population health management company that supports providers with administrative services and care coordination for Medicare Advantage patients. P3's model aggregates and supports the community's existing healthcare resources to build a strong network of community providers working together to deliver highly coordinated and integrated care to our patients with a shared commitment to improving patient outcomes, lowering cost, and delivering a better experience for all. -P3 is headquartered in Nevada with additional offices in OR, CA, AZ and FL.

EOE/AA/M/F/Vets/Disabled

Keywords: P3 Health Partners, Henderson , Claims Auditor, Other , Henderson, Nevada

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