Claims Quality Auditor

DescriptionTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health.The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor. You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures. You will:Research over and under-payment inquiries/appealsCompile and maintain statistical data consistentMaintain departmental production and quality standardsSalary Range: $31.51 - $62.64HourlyQualificationsWe're seeking a self-motivated, detail-oriented, deadline-driven individual with:High school diploma, GED or equivalentFour or more years of medical claims payment experience in an HMO environmentExperience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCSUnderstanding of Medicare Guidelines and COBKnowledge of medical terminologyExperience in benefit determination and claims adjudicationAbility to accurately key 6,000-8,000 keystrokes or type 40-50 WPMUnderstanding of professional and facility reimbursement methodologiesStrong organizational skillsComputer proficiency with Microsoft OfficeKnowledge of claims adjudication systemsFlexibility and adaptabilityUCLA Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.