Claims Auditor/Analyst

Claims Auditor/Analyst - Full-Time - Day Shift

Community Care is hiring for a Claims Auditor/Analyst. This rewarding opportunity is perfect for someone who enjoys team collaboration, being part of a mission driven organization and who shares our mission to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community. This is a full-time opportunity at our Waukesha Office. 

Claims Auditor/Analyst Job Responsibilities:

• Compliance & Quality Assurance Monitoring: Works independently to analyze/audit claims data, claims payment methodologies, and
  fee schedules to assure compliance with Medicare, Medicaid, CCI programs and contracts. Effectively develop audits to monitor member and claim data for fraud, waste and abuse.
• Audit Completion: Develop audit work papers, schedules and summaries to document and support audit procedures performed according to the audit plan. Work collaboratively with external auditors to compile supporting claim documentation, fee schedules and provider
  contracts.
• Reporting- Audits: Prepares oral and written reports of audit activities, processes, results, issues and recommendations for Senior Management. Ability to create claim reports and analyze claim data.
• Claims Investigation and Resolution: Assists the Claims Management staff with analysis and resolution of complex claims and reimbursement methodologies.
• Fee Schedule Monitoring: Assists with the verifying accuracy and preparing Medicare, Medicaid and other fee schedules for loading.
• Policy and Procedure Development: Assists in the development of policies, procedures and quality standards for the agency's claims processing function. 
• Claims System Development and Testing: Assist in identifying, recommending and testing changes to enhance claims applications. 

Claims Auditor/Analyst Job Requirements:

• Education: Required - High school diploma (or equivalent)
• Experience: Required - A minimum of three years of recent experience with Medicare and/or Medicaid claims payment methodologies in a health care insurer or provider environment.
                       Preferred - Experience in a Medicare or Medicaid health plan or healthcare provider environment with auditing and/or analyst experience. 

Claims Auditor/Analyst Job Schedule:

• Monday - Friday 8:00AM - 4:30PM
  

About Community Care
Community Care is a local nonprofit with more than 40 years of experience helping older adults and adults with disabilities live as independently as possible within the community. We coordinate and deliver a full range of supportive services that help more than 13,000 Wisconsin residents live safely, confidently, and with dignity. We are Wisconsin-based with local offices supporting each of the 15 counties we serve. Our dedicated team works with members to develop care plans to meet their health and social needs Together with our community partners, we're committed to providing compassionate, personalized care that empowers members to live a healthy and independent lifestyle.
Compensation and Benefits: 

Our employees make a real difference in people's lives every day, that is why we are proud to offer a compensation package that includes:
   Generous, paid time off
   Competitive pay and benefits (health, dental, vision, etc.) 
   Flexible benefits plan
   Employee referral program
   Coworkers care program
   Retirement plan with employer contribution
   Employee Assistance Program

Community Care is an Equal Opportunity Employer