Vacancy caducado!
NTT Data is hiring a Healthcare Claims Auditer to join our team. Client's business problem to solve:The client relies on the review conducted by the NTT Data Services auditing team to provide the SLA measurements monthly, to ensure payment accuracy on High Dollar claims processed by both the system and manually daily, and for focus audits to drive necessary quality improvements as needed on the account.Positions' General Duties and Tasks:The Claims Auditor is responsible for:
- Reviewing claim samples (Random, High Dollar, Focus) as needed to measure whether procedures, processes and controls are consistently achieved based on established service standards.
- Enter all findings on the audited claims into the proprietary audit tool, and using that tool, provide same day feedback to the individual and Operations Leadership.
- Participate actively in the weekly Root Cause meetings.
- Correctly identify the errors according to category and issue to facilitate follow-up by Operations Leadership and Training.
- Recent experience in insurance/healthcare claims processing or auditing - must be with insurance, managed care or TPA company.
- Knowledge of medical terminology and familiarity with CPT, HCPCS, ICD-9, ICD-10 coding.
- Knowledge of HMO, PPO, Medicare, and Medicaid plans including Medicare Advantage plans as well as experience with Medicare Part D.
- Familiarity with CMS pricing and knowledge of manual pricing requirements to complete these audits accurately, especially in relation to multiple procedures.
Vacancy caducado!