Claims Auditor - Patient Accounting - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

The Claims Auditor is responsible for interacting with outside insurance agencies, patients, and hospital departments including the Regional Business Office on audits, disputed charges and hospital billing and charging problems.

Essential Duties:

• Responsible for coordinating with department leadership and CTO (Clinical Trial Office) on all MCA’s (Medicare Coverage Analyses) or ROF (Research Order Form) with any type of discrepancies to ensure account audits are completed timely.
• Maintains knowledge of any new ROF (Research Order Form) located in the TRUE data base system or ONCOR.
• Perform daily audit of research accounts flagged as related to clinical trial or research program against the medical record to ensure justification of charge.Audit includes releasing claims from billing edit hold.
• Participates in continuous quality improvement analysis to ensure efficiency, compliance and productivity meet the highest standards possible.
• Inter-department communication to validate and finalize audit reviews and process for billing.
• Maintains current status of claims that have been placed on a billing hold status. Department goal is 60 days from assignment.
• Attends and participates in monthly Research Department Meetings.
• Provides explanation of charges and/or billing discrepancies as needed.
• Coordinates and assigns pre-release claims to HIM (Health Information Management) on any issues/questions regarding charges and/or modifiers.
• Completes and finalize returned denied claims from CTO as well as claim billing errors related to patient and insurance inquiries.
• Assist with A/R reconciliation of billed accounts for possible adjustment review to ensure paid accounts are reviewed timely.
• Performs any other duties and responsibilities as assigned.

Required Qualifications:

• Req High school or equivalent

• Req 3 years Experience in a broad medical/surgical background.
• Req 2 years Experience in medical auditing.

• Req Organization/time management skills.
• Req Demonstrates excellent verbal and written communication skills.
• Req Knowledge of general medical terminology.
• Req Knowledge of all insurance types, including government health programs and insurance medical policies.

Preferred Qualifications:

• Pref Specialized/technical training Graduate from an accredited school of Nursing Program as LVN or RN
• Pref Licensed Vocational Nurse - LVN (CA DCA) OR
• Pref Registered Nurse - RN (CA Board of Registered Nursing)

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The hourly rate range for this position is $29.00 - $45.20. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.