Plan Performance Auditor reviewing and analyzing transactions for compliance and accuracy at BCBSNE. Requires strong attention to detail and collaboration with operations personnel.
Responsibilities
Perform quality reviews/audits of claim, enrollment and inquiry transactions.
Research issues identified in reviews by performing additional investigation into applicable documentation, as well as collaborating with operations personnel.
Communicate/report errors and findings to the appropriate stakeholders.
Assist with other Plan Performance audit/work as needed.
Collaborate and serve as a corporate resource to other departments or operational areas.
Coordinate and organize daily workflow, maintain documentation, attend meetings and other administrative activities.
Requirements
Associate's degree in business or related field and 2 years’ experience in the health care industry with claims auditing or claims processing experience
Knowledge of medical terminology and ICD10/ CPT coding
An equivalent combination of education and experience may be substituted for this requirement.
The ability to meet or exceed the attendance and timeliness requirements of their departments.
The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
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