Grow Healthy
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.
Job Overview
The Senior Auditor, Claims Operations (AHN) is responsible for overseeing the daily review and audit of claims adjudicated by both the claims processing system and Claims Examiners. This role plays a key part in ensuring the accuracy, completeness, and compliance of all claims, while identifying discrepancies such as overpayments and underpayments. The Senior Auditor will work closely with cross-functional teams, including the Claims Recovery Unit, to resolve discrepancies, recoup overpayments, and address underpayments. Additionally, this role involves collaborating with the Health Plan Audits team, reviewing audit findings, and providing actionable insights for continuous improvement in claims processing.
Minimum Requirements
High school diploma, GED, or equivalent required.
Minimum of 5 years of experience with claims adjudication, claims auditing, claims processing, and dispute resolution within the managed care industry required.
Must be knowledgeable of Medi-Cal regulations and Managed Care concepts.
Proficient in claims management systems and auditing tools.
Deep understanding of healthcare claims adjudication processes, including coding, billing, and reimbursement methodologies.
Familiarity with health plan audit requirements and regulatory compliance standards.
Compensation
$31.02 - $38.78 hourlyCompensation Disclaimer
Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.
Benefits & Career Development
Job Advertisement & Application Compliance Statement
AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.