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Manager, Clinical Claims Auditing

ent Russian OR Chinese OR Shanghainese OR Fukienese Growing, well established and successful MLTC company is seeking an experienced Manager for Clinical Claims Auditing. The ideal candidate will possess hands-on experience in claims processing, utilization/case management in a clinical practice or managed care organization. Candidate needs to have experience reviewing and quantifying the accuracy of clinical data. Also responsible for recommending corrective action plans. Candidate must be comfortable working with multiple electronic Patient Health Information databases. Knowledge of: CCMS, Sungard Macess Service Module, RightFax to name a few. You will be using your experience to perform audit procedures that include identifying and validating payments of claims. Research requirements necessary to make recommendations on best practices from a care management perspective. Will act as a liaison between claims and care management to resolve issues. This is a high level position for an experienced professional. Qualifications Needed: • Minimum degree AA • Knowledge of DOH and CMS regulations • Experience working with any of the following softwares: CCMS, Citrix, VolP, RightFax. • Experience working with EMR • Knowledge of Visio, MACESS or MHS archival system • Experience using EXCEL  • Proficiency with ICD-10 codes and medical terminology

West Hollywood, California