Remote Internal Claims Auditor

Company Description

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.  

Join us as we put healthcare on a better path!!  

Job Description

WHAT YOU’LL BE DOING

• Understand and stay current with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations. 
• Ensure accuracy of claims processing and contract logic builds through internal audit processes.
• Perform targeted audits of claims processing including, but not limited to, high dollar payments, benefit matrix, interest payments, pre-payment and post-payment audits, and multiple procedure claims.
• Perform quality audits of claims staff, eligibility staff, and system logic.
• Perform audits of new client setup in the claims processing software.
• Run access queries as needed for administrative purposes. 
• Other duties and responsibilities as assigned. 

Qualifications

WHAT YOU'LL NEED TO HAVE

• Minimum 3 years of experience in the healthcare or managed care industry, including claims/reimbursement experience, professional analytics-related experience and experience working on/managing major projects
• 1-3 years auditing experience in the healthcare industry
• Advanced to expert proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access
• Able to problem solve, exercise initiative, and make low to medium level decisions
• Thorough understanding of current federal, state and local healthcare compliance requirements
• Ability to meet deadlines and prioritize tasks; collect, correlate, and analyze data
• Ability to work independently with minimal supervision and as part of a team
• Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player
• Effective written and oral communication

WOULD LOVE FOR YOU HAVE

• Bachelor’s degree in healthcare informatics, business administration, or related field, or equivalent in experience and education 
• Certified Professional Coder strongly recommended
• Prior claims processing experience within Eldorado HealthPac Claims Adjudication System is a plus
• Claim coding experience, coding edits experience and APC Pricing knowledge
• CPT and ICD coding knowledge 

Additional Information

The base pay range for this role is between $19.00 to $21.91 per hour, paid bi-weekly

All your information will be kept confidential according to EEO guidelines.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.  

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager. 

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.