Description A Hospital in Los Angeles is in the need of a Medical Claims Auditor. The Medical Claims Auditor must have experience with clinical trials. The Medical Claims Auditor is responsible for interacting with outside insurance agencies, patients, and hospital departments including the Regional Business Office on audits, disputed charges and hospital billing and charging problems Responsible for coordinating with department leadership and CTO (Clinical Trial Office) on all MCA’s (Medicare Coverage Analyses) or ROF (Research Order Form) with any type of discrepancies to ensure account audits are completed timely. Maintains knowledge of any new ROF (Research Order Form) located in the TRUE data base system or ONCOR. Perform daily audit of research accounts flagged as related to clinical trial or research program against the medical record to ensure justification of charge. Audit includes releasing claims from billing edit hold. Participates in continuous quality improvement analysis to ensure efficiency, compliance and productivity meet the highest standards possible. Inter-department communication to validate and finalize audit reviews and process for billing. Maintains current status of claims that have been placed on a billing hold status. Department goal is 60 days from assignment. Attends and participates in monthly Research Department Meetings. Provides explanation of charges and/or billing discrepancies as needed. Coordinates and assigns pre-release claims to HIM (Health Information Management) on any issues/questions regarding charges and/or modifiers. Completes and finalize returned denied claims from CTO as well as claim billing errors related to patient and insurance inquiries. Assist with A/R reconciliation of billed accounts for possible adjustment review to ensure paid accounts are reviewed timely. Performs any other duties and responsibilities as assigned.Requirements Medical Billing, Medical Claims, Clinical Trials, HIMRobert 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.Robert Half will consider for employment qualified applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. 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.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .
