Medical Claims Auditor II (Temporary role) in Woburn, MA at Beacon Health Options

Date Posted: 4/1/2018

Job Snapshot

Job Description


The Medical Claims Auditor will work under the direction of the Manager of Quality Control and be responsible for supporting quality initiatives in the Service Center through a variety of auditing activities.   These activities include but are not limited to the review of work performed in the Network Operations, Network Development and Claims departments.  The person hired in this role will contribute in the identification of opportunities to improve work processes and collaborate in the development of solutions to problems found in the work that is audited. This is a key role in the successful operations of the Woburn Service Center.

**This is a temporary role**

Position Responsibilities:

  • Review work done by various departments within the Service Center, including Claims, Network Operations and Network Development

  • Consistent and methodical review according to established guidelines

  • Meet all deadlines (weekly/monthly/quarterly) for review of work

  • Clearly state what is identified as a deficiency or error in work being reviewed

  • Work proactively with the Manger of Quality Control to ensure quality recommendations are made and implemented 

  • Maintain thorough and complete knowledge of assigned functional processes to effectively evaluate accuracy levels 

  • Ensure timely and accurate quality data is reported

  • Research and assist to define regulatory or accreditation requirements as needed

  • Other Duties as assigned

Position Requirements:

Education: Bachelor’s Degree Required

Licensure:  Certification in auditing, or certification/licensure related to the functional areas being audited would be beneficial

Relevant Work Experience:   Minimum of 1 year experience in a Managed Healthcare setting (with a strong understanding or Managed Healthcare operations, background in behavioral health would be beneficial)

Knowledge, Skills & Abilities:

  • Detail-oriented with ability to work independently

  • Solid understanding of the functional activities associated with Credentialing, Provider Relations, Provider Data, Network Development and Claims

  • Strong analytical and problem-solving skills with an orientation toward demonstrating results

  • Professional demeanor with strong written communication skills

  • Proficiency in Microsoft Excel


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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled