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Claims Quality Review Auditor - Healthcare
JOB SUMMARYThe Claims Quality Review Auditor is HYBRID position accountable for auditing various claims to ensure quality and accuracy to related benefit payments, contract interpretation, and compliance with policies and procedures and regulatory guidelines. Makes recommendations to improve quality, workflow processes, policies and procedures.ESSENTIAL FUNCTIONS OF THE ROLETracks and trends audits in an effort to identify root cause errors to providers; provides feedback.Ensures that the department's procedural manuals consistently help adherence to regulatory guidelines, internal policies and procedures related to claims processing and departmental accuracy standards related to claims payment.Develops practi
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