Collective Health
Combining technology and the human touch to improve healthcare for employers and their people.
Health Insurance • Health Benefits
501 - 1000
Senior Compliance Claims Auditor
August 13
🏢 In-office - San Francisco
Collective Health
Combining technology and the human touch to improve healthcare for employers and their people.
Health Insurance • Health Benefits
501 - 1000
Description
• Supporting the Company’s internal compliance operations • Developing and strengthening Collective Health’s claims compliance program • Auditing medical claims received from providers • Managing internal and external audits • Providing timely input on compliance-related issues • Assisting with compliance risk assessments and audit readiness • Collaborating with team members to identify and mitigate compliance risk
Requirements
• Bachelor’s degree or equivalency required, preferably in a business, technology or healthcare field • At least 5 years of experience auditing medical claims • Coding credential is required (Preferred AHIMA CCS; Required either CPC, CPC-A, RHIT, or CCS) • Broad experience and knowledge of coding and reimbursement systems • Broad experience and knowledge of healthcare and healthcare business practices and principles • Broad experience and knowledge of third-party payer practices • Broad experience and knowledge of healthcare claims data and analytics • Knowledge of federal laws related to ERISA group health plans • Knowledge of the 5010 data standards and practical understanding of EDI transmission files • Knowledge of subrogation, coordination of benefits, and claims hierarchy standards • Knowledge of state and federal laws which apply to claims processing • Experience developing or enhancing a compliance program is desired • A CHC certification is preferable • Proven ability to build relationships and collaborate effectively • Strong organizational and project management skills • Proficiency with technology tools • Critical thinking and decision making skills • Excellent written and verbal communication skills
Benefits
• Eligible for stock options • Health insurance • 401k • Paid time off
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