California Licensed Claims Auditor

Job Summary

A company is looking for a Claims Audit Specialist who ensures the timely and accurate payment or denial of claims while adhering to regulations and policies.

Key Responsibilities

• Audit complex Medicare and Medi-Cal claims for accuracy and compliance
• Review processed claims for payment accuracy and maintain documentation of audit findings
• Participate in annual claims audits and provide feedback on claims processing errors

Required Qualifications

• Bachelor's degree in a relevant field or equivalent professional experience
• Minimum of five years of experience with Medicare and Medicaid claims processing and auditing
• Experience in processing and auditing disputes, appeals, and recoveries
• Proficient in Microsoft Excel and knowledgeable in health plan insurance regulations
• Experience with CMS and Medi-Cal healthcare claims