Healthcare Claims Auditor

Join the frontlines of today's healthcare transformation at VillageMD as a Claims Audit Specialist (Remote)!

Why VillageMD?

At VillageMD, we're looking for a Claims Audit Specialist to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.

We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.

Could this be you?

A Claims Audit Specialist independently performs end to end audits of Operational area to ensure accuracy of departmental processes as they trace back to source and identify (if necessary) process improvement opportunities.

How you can make a difference

• Conduct daily quality reviews of operations department processes (i.e. eligibility, enrollment, claims processing and pricing, configuration contract loads, etc)
• Respond to first and second level rebuttals in a timely manner
• Track and maintain quality results for appropriate distribution
• Communicate audit results in a structured report format
• Identify and quantify issues and recommend audit criteria to validate financial impact
• Navigate audit tools and prepares ad hoc reports using Microsoft Excel or Access to summarize audit findings
• Assist with identification and communication of process improvement opportunities across operation area's based on quality audit reviews
• Assist with special projects and other duties as assigned

Skills for success

• A bias for action and pragmatic solutions
• Ability to work quickly with great attention to detail
• Technical claims handling experience
• Knowledge of all products and all types of claims
• Computer literate with an above-average typing speed
• Demonstrate superb verbal and written communication skills
• Ability to work in a fast-paced environment with changing priorities
• Ability to work within tight timeframes and meet strict deadlines
• Ability to exercise sound judgment
• Prior experience as a Claims Analyst/Processor/Specialist or equivalent, ideally within a similar setting
• Ability to resolve conflict and diffuse tensions
• A low ego and humility; an ability to gain trust through strong communication and doing what you say you will do

Experience to drive change

• High School Diploma or GED required
• 3+ years of direct healthcare claims processing
• EZ-Cap experience preferred

How you will thrive

In addition to competitive salaries, a 401k program with company match and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.

Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.

Our unique VillageMD culture – how inclusion and diversity make the difference

At VillageMD, we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. 

Those seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

For Colorado Residents only: The base compensation range for this role is $23.00 to $29.00. At VillageMD, compensation is based on several factors including but not limited to education, work experience, certifications, location, etc. This role may be eligible for annual/quarterly bonus incentives (if applicable), and the selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan with company match. 

Explore your future with VillageMD today.