The Claims Prepayment Auditor is responsible for the internal auditing of claim accuracy of claims processed according to the benefit structure to ensure accurate adjudication of healthcare claims payment. The Claims Prepayment Auditor must be thoroughly familiar with claims processing/adjudication processes, fee schedules, contract terms, standard operating procedures, and DMAS/DHHS regulations. The Claims Prepayment Auditor is also responsible for communicating with internal and external customers on the outcome of the integrity of medical payments for the organization through verification of the accuracy of data-entered information. It is expected that the Claims Prepayment Auditor is able to research issues, problem resolve and make appropriate decisions as it relates to claims processing. The Claims Prepayment Auditor must also be capable of developing a working relationship with regulatory agencies. The level of involvement depends on the specific line of business. The Claims Prepayment Auditor may provide education and feedback to staff involved in the related processes.
In addition, the Claims Prepayment Auditor is responsible for all aspects of High Dollar quality assurance within the Claims job family. Conducts High Dollar audits and provides feedback to reduce errors and improve processes and performance.
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.
We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
Our mission is to inspire healthy living within the communities we serve!