Auditor, Insurance Claims

Responsibilities

• Read and analyze EOB’s and make proper adjustments according to PDS claims processing criteria
• Sends appeals to insurance carriers with justification as to why dental treatment should be paid.
• Audit accounts to ensure proper fees have been posted.
• Works with CBO team to maximize office collections and minimize adjustments.
• Communicate issues and suggestions to improve processes.
• Ensure compliance with Company policies as well as State, Federal and other regulatory bodies.
• Participate in meetings as required.
• Maintain an appropriate professional appearance and demeanor in accordance with Company policy.
• Other duties as assigned by management.

Requirements

• Equivalent to high school diploma or general education degree (GED)
• 2-4 Years of related experience in the dental field
• Preferred: EPIC knowledge, Bachelor’s Degree and 3 to 5 years of related experience, Prior experience as a claims auditor within a group practice environment.

Qualifications

• Ability to multi-task effectively without compromising the quality of the work
• Excellent interpersonal, oral and written communication skills
• Detail oriented, organized, process focused, problem solver, proactive, customer service focused
• Ability to draw conclusions and make independent decisions with limited information
• Ability to respond to common inquiries from customers, staff, regulatory agencies, vendors, and other members of the business community
• Self-motivated, reliable individual capable of working independently as well as part of a team
• Problem solving skills to gather & analyze information in order to identify and resolve problems in a timely manner
• Ability to research information and analyze data to arrive at valid conclusions, recommendations, and plans of action
• Active listener who actively shares ideas in a constructive and positive manner by listening to and objectively considering ideas and suggestions from others

Skills

• Ability to draw conclusions and make independent decisions with limited information
• Ability to respond to common inquiries from customers, staff, regulatory agencies, vendors, and other members of the business community
• Self-motivated, reliable individual capable of working independently as well as part of a team
• Problem solving skills to gather & analyze information in order to identify and resolve problems in a timely manner
• Ability to research information and analyze data to arrive at valid conclusions, recommendations, and plans of action
• Active listener who actively shares ideas in a constructive and positive manner by listening to and objectively considering ideas and suggestions from others

Pay

$22.00-$29.80 / Hourly

Schedule

N/A

Benefits

• Medical, dental, and vision insurance
• Paid time off
• Tuition Reimbursement
• 401K
• Paid time to volunteer in your local community

Company Info

PDS Health is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.