Healthfirst

The Clinical Claims Auditor examines clinical claims and service authorizations for accuracy and to prevent claim errors. Position reports to the Manager of Clinical Claims Auditing.

Duties/Responsibilities:

• Examines provider claims and service authorizations for completeness, accuracy, and medical necessity and proposes resolutions per internal and regulatory processes.
• Communicates to relevant teams and providers any claims/ authorization inaccuracies found along with recommended solutions.
• Follows up to ensure outstanding issues are resolved and to increase and promote overall satisfaction.
• Compiles recurring issues to help educate teams on error prevention.
• Completes documentation in Patient Health Information database (CCMS) and in accordance with all other company procedures. 
• Additional duties as required.

Minimum Qualifications: 

• HS Diploma or GED

 Preferred Qualifications: 

• Associate's Degree
• Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese.
• Relevant previous work experience including but not limited to claims, service authorizations, health insurance, and Medicaid managed care products.
• Telecommuting role

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400

• All Other Locations (within approved locations): $41,101 - $60,320

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.