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Take 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/appeals
Compile and maintain statistical data consistent
Maintain departmental production and quality standards
Salary Range: $31.51 - $62.64 Hourly
Qualifications
We’re seeking a self-motivated, detail-oriented, deadline-driven individual with:
High school diploma, GED or equivalent
Four or more years of medical claims payment experience in an HMO environment
Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS
Understanding of Medicare Guidelines and COB
Knowledge of medical terminology
Experience in benefit determination and claims adjudication
Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM
Understanding of professional and facility reimbursement methodologies
Strong organizational skills
Computer proficiency with Microsoft Office
Knowledge of claims adjudication systems
Flexibility and adaptability
UCLA 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.
At UCLA Health, you can help heal humankind, one patient at a time by improving health, alleviating suffering and delivering acts of kindness. As you do, you’ll achieve great things in your life and your career. We’re a world-class health organization with four hospitals consistently recognized among the nation’s very best as well as an internationally-renowned medical school, primary and specialty care clinics and much more. Within our dynamic, innovative and growing organization, you’ll find exceptional opportunities to make the most of your abilities in a supportive, empowering and inclusive environment. If you embrace our values of Integrity, Compassion, Respect, Teamwork, Excellence and Discovery we invite you to see all you can accomplish at UCLA Health.
