Horizon House is an Equal Opportunity Employer (M/F/Veteran/Disability/Sexual Orientation/Gender Identity).

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Claims Auditor
Req Code:2021:1310-008
County:Philadelphia County, PA
FT/PT:Full Time
Location:1310-Info. Syst & Tech. (
Schedule:Monday-Friday 9am-5pm
  
Job Description/Essential Functions:
Horizon House, a non-profit organization, has been widely recognized for its services as a provider of community-based behavioral health, intellectual disabled and homeless services in Eastern Pennsylvania and the state of Delaware. Each year, Horizon House provides a continuum of services at over 100 sites to over 4,5000 adults with psychiatric or developmental disabilities, drug and alcohol addictions, and/or homelessness. A pioneer in the field of community-based rehabilitation, Horizon House is widely recognized for its innovative approach to the delivery of services in a community setting. Currently, we are seeking full time Claims Auditor to work in our IT Division.

Below are some of the items this position are responsible for:
  • Ensure claims produced from the Electronic Health Record (EHR) system are processed accurately and according to government standards.
  • Conducting claims assurance assessments, reviewing statistical samples, filing financial data and reviewing third-party audits.
  • Maintained statistics for productivity and trending purposes. Utilizes appropriate methodologies (charts, graphs) to disseminate information in a user friendly fashion.

 

Job Qualifications:

A successful applicant will have the following:

  • Bachelor’s degree in Statistics, Mathematics, or related field with a minimum of two (2) years of experience in operations research, market research, or applied statistics and working in healthcare and/or medical claims-level data or any combination of experience or training that would provide the level of knowledge , skills or ability required.
  • Technical skills/knowledge in one or more of the following: multivariate analysis, regression analysis and forecasting, sampling data modeling or SPSS.
  • Claims auditing, claims processing, medical coding and/or billing experience, International Classification of Diseases Ninth Revision (ICD-9), ICD-10 EHR experience; statistical experience.
  • Strong Critical/Strategic Thinking, Problem Solving, Customer Service Focus and Time Management.
  • Excellent organizational, oral/written communication and interpersonal skills.
  • Ability to manage multiple task, timelines and prioritize assignments.
  • Must be proficient with Medicare/Medicaid and managed care guidelines/ operations. Understanding of federal and state laws and regulations in medical reimbursement.
  • Strong MS Office application skills (advanced knowledge of Excel and/or Access.
  • Self-starter, able to initiate activity without the need for supervision.
  • Works independently following established policies, procedures and practices.

Scope:

  • Required sitting for long periods of time.
  • Light lifting and/or carrying, not to exceed 25 lbs.


Horizon House offers competitive compensations and a comprehensive benefit package including: medical & dental, (9) nine paid holidays, paid time off, tuition reimbursement, retirement savings plan, voluntary tax sheltered annuity, transit benefit program, opportunities for advancement and more.


EOE: M/F/Veteran/Disability/Sexual Orientation/Gender Identity

  
    

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