Claims Auditor Jobs

Our client is a great hospital system located in Spokane, WA and they provide excellent paid classroom training in a supportive environment to ensure you have all the skills and tools necessary to be successful. We are constantly looking for hard-working, talented people who share our commitment to excellence.

Our comprehensive benefit package includes health and dental benefits, short/long term disability plans, 401K with company matching, a generous vacation policy and more. We also offer an onsite gym, café and coffee shop.

The compensation package includes a base pay of $60,000-$70,000 plus bonus potential!

The Auditor investigates claims data to identify overpaid/incorrectly paid claims and initiates the recovery of that money for our clients. The position requires extensive online research in clients’ claims systems, internal research materials, internet resources and phone communications with members, employers, providers and other insurers. The Auditor is also responsible for handling administrative duties including but not limited to, invoice preparation, invoice follow-up, retractions and file maintenance.

Essential Duties & Responsibilities

Reviews/audits healthcare claims, and investigates to determine Medicare/Commercial primacy by recognizing and investigating known indicators, and communicating with healthcare providers, employers, members and/or Medicare representatives to gather information to support the primacy determination. Utilizes all available resources to maximize identification and recovery of overpayments, and complies with all company policies/procedures and state and federal laws during the investigation process.

Answers all phone calls in a timely fashion and resolves issues satisfactorily and in compliance with company policies and procedures.

Performs administrative tasks required for the invoicing and recovery process.

Creates and maintains files in accordance with management policies and guidelines by obtaining and attaching all appropriate documentation to clearly identify an audit trail for the audit performed.

Closes all files in accordance with required coding and approvals according to division guidelines.

The ability to work at our Facility and maintain our regular work schedule of Monday through Friday, 8:00 – 5:00.