about 1 month ago
12 Dec 00:00
Supervisor of Provider Reimbursement and Claims Audit
Job Id: 4954
Are you looking to make a career change to a rapidly growing company? This exciting opportunity offers a competitive salary plus an excellent benefits package including Dental, Vision, Health, Pension Plan, Retirement, 401K Plan, PTO and Tuition Assistance. Does this position match your future career goals? Then this opportunity could be the right fit for you.
- Perform accurate and timely auditing of provider claim inquiries and provider claim for payment accuracy.
- Audit complex and escalated provider claims for payment accuracy.
- Conduct department audits and workflow processes.
- Make sure audits are up to standards with company policies and procedures.
- Create audit programs and workflows for new products and new markets.
- Create and present reports on audit findings, and action plan for resolutions.
- Respond to issues or questions effectively.
- Be a leader of provider reimbursement and claims audit staff.
- Associate’s degree in related field or equivalent experience.
- 6 plus years of combined medical or pharmacy claims processing, claims pricing, and supervisory or lead experience.
- 1 plus years’ experience leading in a functional area and managing cross functional teams for large scale projects including hiring, training, assigning work and managing the performance of staff.
- Efficient in Microsoft Office Applications
- Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts required.
- Knowledge of CPT/HCPCS Coding required.
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Direct Hire
- Paid PTO
- Pension and Retirement Plans
- Tuition Assistance
Ask for Scott
Ajulia Executive Search is a New Jersey based Executive Search Firm specializing in retained searches in multiple sectors, including Manufacturing, Finance, IT, Legal, and Pharmaceutical. We have a nationwide client base and offer services in temporary and direct hire placements.