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 MCAs (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 includes releasing claims from billing edit hold.
• Participates in continuous quality improvement analysis to ensure efficiency compliance and productivity meet the highest standards possible.
• Interdepartment 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 prerelease 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)

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin protected veteran status disability or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix Dfor specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone ator by email at. Inquiries will be treated as confidential to the extent permitted by law.

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