Medical Claims Auditor/Trainer

Location:  Clearwater, FL

Premier Administrative Solutions is a Third Party Administrator (TPA), headquartered in St. Petersburg, Florida with satellite offices in Columbia, SC and Louisville, KY. Premier has been a leader in developing, implementing, and managing administrative services for self-funded and fully-insured programs, individual and group products in both the government and commercial arenas.

Summary:

The Claims Auditor performs claim audits for randomly selected claims for all examiners and auto adjudication.

Essential Duties and Responsibilities:

  • Audits all claims in excess of Claim Examiners payment authority limits
  • Authorizes and releases claims in excess of Claim Examiners payment authority limits
  • Refers claims in excess of Auditor’s authorization limit to Claims Manager for approval
  • Performs target claim audits as directed
  • Prepares and distributes monthly audit reports by required due date
  • Communicates audit findings with Examiners
  • Reviews claim audit results with Claims Manager on a regular scheduled basis
  • Notifies Claims Manager of any training needs identified during routine auditing
  • Provides training to newly hired Claims Examiners in the use of the claims adjudication system and the application of processing guidelines
  • Provides ongoing training to Claims Examiners as identified by auditing process
  • Assists with claims processing, claim adjustments and appeals and grievance resolution process as needed

Other Responsibilities:

  • Adheres to the policies and procedures of Premier Administrative Solutions
  • Maintains strict confidentiality of client, company and personnel information
  • Demonstrates a strong commitment to the mission and values of the organization
  • Adheres to company attendance standards
  • Performs other duties as assigned

Supervisory Responsibilities:   None

Competencies:

  • Strong organizational and interpersonal skills
  • Excellent written and verbal communication skills
  • Detail oriented
  • Ability to multi-task and work independently

Qualifications:

  • A minimum of five (5) years of claims processing experience is required
  • Prior auditing experience is preferred
  • Knowledge of medical and dental coding systems
  • Knowledge of medical terminology

Education and/or Experience:

A high school diploma or equivalent is required

Certificates, Licenses, Registrations:

Must be able to obtain 5-40 Health Adjuster’s license within one (1) year of employment

Computer Skills:

Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook

Environmental Factors/Physical Demands:

Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.

To apply, please forward resume to careers@premieradministrativesolutions.com

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