CLAIMS AUDITOR

Company: MetroPlus Health Plan
Location: Jersey City
Posted on: January 16, 2022

Job Description:

About NYC Health + HospitalsMetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus ' network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. -Position OverviewIncumbent audits completed data entry and adjudicated claims. Incumbent produces detailed monthly statistical reports to assist the Manager in assessing employee 's performance as it relates to quality.Job Description

• Audit work of claims examiners to ensure quality.
• Identify policies or common errors requiring retraining sessions.
• Participate in quality projects as required.
• Collect, analyze data, identify trends, write reports (i.e., the monthly and quarterly reports) and present findings to the appropriate Claims Service management personnel.
• Other duties as assigned by the Director of the Claims Department and the Manager of the Claims Service UnitMinimum Qualifications
  • Must be able to perform all the duties and responsibilities of subordinate claims examiners within the department.
  • Must be able to communicate adequately both verbal & written.
  • Must have excellent interpersonal skillsProfessional Competencies
    • Integrity and Trust
    • Customer Focus
    • Functional/Technical skills
    • Written/Oral Communication

Keywords: MetroPlus Health Plan, Jersey City , CLAIMS AUDITOR, Accounting, Auditing , Jersey City, New Jersey