Description

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

Compensation 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

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

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.

AltaMed Health Services Corporation is committed to providing equal employment opportunities for all qualified individuals. We strictly prohibit discrimination in employment based on race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin, age, medical condition, physical or mental disability, military or protected veteran status, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical conditions, genetic information, or any other characteristic protected by local, state, or federal law, ordinance, or regulation.

We are committed to promoting equality and inclusivity beyond our recruitment and hiring processes. We aim to create a respectful, valued, and inclusive workplace through training, advancement opportunities, and access to resources and support. We focus on fostering a diverse workforce because it enriches our organization and improves our ability to effectively serve our clients and community. We encourage individuals from all backgrounds to apply and join us in our mission to create a positive impact.

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