Claims Audit Analyst
The Claims Audit Analyst will be responsible for ensuring the integrity of the affiliate provider medical billing coding and revenue cycle. Responsible for performing audits to ensure claims are processed accurately, timely and in compliance with contract terms, federal and state regulations and third-party payor rules. Will also serve as liaison to affiliate providers to ensure smooth onboarding and orientation to claims billing process.
- Serves as HPMG expert resource for affiliate provider billing, coding and revenue cycle, and ensures that claims are processed and paid accurately, timely and that the provider charges are appropriate, to include but not limited to:
- Performs claims auditing functions.
- Reviewed practice related information and invoice adjudication/payment, general ledger mapping and compliance with contract terms and policies/procedures.
- Determines benefit eligibilities of claims submissions.
- Serves as HPMG lead for all KP claims system administration requirements.
- Responsible for various full life cycle affiliate provider tasks.
- Performs all other essential duties as assigned.
- Associates degree in medical coding. Bachelor’s degree in a healthcare field preferred.
- 3 years of medical claims coding experience.
- At least 1 year of claims auditing experience.
- Medical coding certification.
- Risk Adjustment Certification (CRC) preferred.
- Must have knowledge of CPT and modifiers, ICD-10, NPI, POS and CMS 1500 guidelines and industry standard reimbursement models (FFS, case rate, per diem, capitation, etc.).
- Strong analytical, quantitative, problem solving, and organizational skills.
- Strong communication and interpersonal skills.
- Requires strong attention to detail and excellent organizational skills.
- Ability to work independently, effectively, and efficiently.
- Must have advanced proficiency in MS Excel.
HPMG offers an excellent benefit packageHPMG is committed to offering industry-leading benefits such as 100% company-sponsored, comprehensive medical and dental insurance for you and your family, life insurance, long-term care insurance, pension and profit sharing plans, retiree medical, paid time off, extended sick time, holidays, and more.
Hawaii Permanente Medical Group (HPMG) is the state's largest and most experienced multi-specialty group with over 600 physicians and providers supported by more than 100 administrative employees. Together, we are dedicated to providing the highest quality clinical care and services possible to Kaiser Permanente members in Hawaii. Many know Hawaii as an attractive tourist destination with beautiful scenery, sunny weather, friendly people, and a host of cultural and recreational opportunities. These elements, and others, make Hawaii an excellent place to live.