[Hiring] Claims Audit Analyst @WelbeHealth

Role Description

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option (PACE) to the most vulnerable senior population while serving as a care provider and care plan to those individuals we serve. Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures.

• Review processed claims for accuracy prior to payment while maintaining acceptable levels of claim’s aged inventory by verifying various aspects of the system and claim.
• Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing errors, and monetary discrepancies.
• Move claims free of processing errors through for full adjudication and return claims with errors back to the claims team for corrections.
• Provide feedback to the Oversight & Monitoring Manager on claims processing errors, quality improvement opportunities, and configuration change requests, when applicable.

Qualifications

• Minimum of three (3) years of experience processing and auditing Medicare and Medicaid professional, institutional, and dental health insurance claims.
• Working knowledge of the health plan insurance industry, CPT/HCPCS procedure codes, ICD-10 codes, and relevant federal and state regulations.
• Experience working with CMS and Medicaid healthcare claims highly preferred.
• Demonstrated skills within Microsoft Office Applications, including Excel.

Benefits

• Apply your claims expertise in meaningful ways as we rapidly expand in an encouraging and loving environment.
• Medical insurance coverage (Medical, Dental, Vision).
• Work/life balance – 17 days of personal time off (PTO), 12 holidays observed annually, sick time.
• Advancement opportunities - We’ve got a track record of hiring and promoting from within.
• Compensation consists of base salary plus bonus.
• WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits.
• Actual compensation will be determined based on experience and relevant qualifications.

Compensation Offering

$67,829.78 — $89,535.30 USD

COVID-19 Vaccination Policy

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer.

Beware of Scams

Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to [email protected].