Job Information
Robert Half Claims Auditor in Oakland, California
Description Unlock Your Next Career Move: Claims Auditor/Trainer Are you meticulous, compliance-driven, and passionate about streamlining healthcare operations? Robert Half is recruiting for a Claims Auditor/Trainer to ensure claims are processed accurately, meet legal standards, and enhance staff knowledge of benefit requirements and regulations. Key Responsibilities: Claim Auditing & Compliance: Conduct audits of processed claims (paid, pending, denied) to verify accuracy in medical coding (ICD-10, CPT, HCPCS), benefit application, and compliance with California's Knox-Keene Act and Medi-Cal regulations. Training & Staff Development: Develop and deliver training for Claims Examiners, including creation of educational materials on workflows, policy updates, and new technologies. Research & Issue Resolution: Investigate complex claim issues, provider disputes, and appeals; identify root causes for systemic issues and recommend corrective actions. Reporting & Data Analysis: Track and report statistical data on MSO quality and production. Prepare regular reports for management. Regulatory Liaison: Maintain current knowledge of state and federal billing laws (CMS/Medicare) to ensure compliance and readiness for audits. **Other duties as assigned by senior management. If you are a detail-oriented detail oriented with experience in claim auditing, training, and regulatory compliance, we want to hear from you! Apply today and call us at (510) 470-7450 to take the next step in your career with Robert Half. Ready to make an impact? Apply now! Requirements QUALIFICATIONS: · High school diploma, GED or equivalent · Four or more years of medical claims payment experience in an HMO environment · Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS · Understanding of Medicare Guidelines and COB · Knowledge of medical terminology · Experience in benefit determination and claims adjudication · Understanding of detail oriented and facility reimbursement methodologies · Strong organizational skills · Computer proficiency with Microsoft Office · Knowledge of claims adjudication systems (Easy Cap a plus) · Flexibility and adaptability TalentMatch®
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
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