This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC (Department of Managed Health Care), and DHS.
This position includes the responsibility for routine hospital and professional audits, complex audits on individual or random training, and focused claims to identify exceptions to established claims adjudication requirements for claims processing, payment and procedural accuracy.
In addition, this position is responsible to assist with eligibility identify (e.g. COB, ESRD) and Letters of Agreements as required.
To maintain in strict confidence, all member, provider, and Health Plan information to which Claims Auditing Specialist has access.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.