Claims Auditor

Location: Oak Brook, IL
Date Posted: 04-17-2018
About us:
Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates.   We are created and managed by experienced industry professionals in healthcare. As a leading provider of contract, contract to perm, and direct placement recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.
Open Position:
We are seeking a Claims Auditor. The Claims Auditor is responsible for new Claims Analyst training and auditing of trainee claim processing. To oversee and provide secondary review of pending cases and Medical Records ordered by Claims Analyst 1 for appropriate processing; to analyze and process a variety of claim files to ensure the execution of standardized claim protocol and claim handling.
  • Follow claims adjudication process to assure that all claims are adjudicated in accordance with CMS rules and regulations in conjunction with the client company guidelines
  • Review Medicare, Medicaid and Commercial services for appropriateness of charges and will apply pre-existing guidelines during claims processing
  • Pend claims and order Medical records for review and investigation of possible gross misrepresentation
  • Authorize claim payments within established limits; otherwise forward to Claims Manager
  • Process refunds and letters of dual coverage (when applicable);
  • Identify process improvement opportunities within the claim department and recommend system enhancements

For More Information:

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