Auditor - Provider Recovery - Inland Empire Health Plan

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.

Key Responsibilities:

1. Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.  
2. Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
3. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.
4. Promote teamwork and maintain effective working relationships with others throughout the organization.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

Education & Experience

• Four (4) years claims processing experience including Medicare and Medi-Cal
• Two (2) years of experience auditing claims in a managed care environment including contract and financial DOFR interpretation
• Experience with MS Office applications

Key Qualifications

• Strong analytical and problem-solving skills
• Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings
• Microsoft Office including being able to manipulate large data sets in Excel files
• Excellent oral and written communication skills

Start your journey towards a thriving future with IEHP and apply TODAY!