About the job
Grow Healthy
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.
Job Overview
The Claims Auditor will be responsible for the accurate review and auditing of claims that are adjudicated by the system and the Claims Examiners. The auditor will suggest process improvements to management and act as a resource of information to all staff. The Claims Auditor will identify root cause issues, overpayments, coordinate with the Claims Recovery Unit, and assist with review and responses for Health Plan Audits
Minimum Requirements
- HS Diploma or GED required.
- Minimum of 3 years of experience with Claims Processing required.
- Must be knowledgeable of Medi-Cal regulations.
- Knowledge of Medicare and Commercial rules and regulations preferred.
- Knowledge of medical terminology
- Must have an understanding to read and interpret DOFRs and Contracts.
- Managed Care concepts.
- Must have strong organizational and mathematical skills.
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