Unlock Your Next Career Move: Claims Auditor/Trainer Are you meticulous, compliance-driven, and passionate about streamlining healthcare operations? Robert Half is recruiting for a Claims Auditor/Trainer to ensure claims are processed accurately, meet legal standards, and enhance staff knowledge of benefit requirements and regulations. Key Responsibilities: Claim Auditing & Compliance: Conduct audits of processed claims (paid, pending, denied) to verify accuracy in medical coding (ICD-10, CPT, HCPCS), benefit application, and compliance with California's Knox-Keene Act and Medi-Cal regulations. Training & Staff Development: Develop and deliver training for Claims Examiners, including creation of educational materials on workflows, policy updates, and new technologies. Research & Issue Resolution: Investigate complex claim issues, provider disputes, and appeals; identify root causes for systemic issues and recommend corrective actions. Reporting & Data Analysis: Track and report statistical data on MSO quality and production. Prepare regular reports for management. Regulatory Liaison: Maintain current knowledge of state and federal billing laws (CMS/Medicare) to ensure compliance and readiness for audits. **Other duties as assigned by senior management. If you are a detail-oriented detail oriented with experience in claim auditing, training, and regulatory compliance, we want to hear from you! Apply today and call us at (510) 470-7450 to take the next step in your career with Robert Half. Ready to make an impact? Apply now!
Unlock Your Next Career Move: Claims Auditor/Trainer Are you meticulous, compliance-driven, and passionate about streamlining healthcare operations? Robert Half is recruiting for a Claims Auditor/Trainer to ensure claims are processed accurately, meet legal standards, and enhance staff knowledge of benefit requirements and regulations. Key Responsibilities: Claim Auditing & Compliance: Conduct audits of processed claims (paid, pending, denied) to verify accuracy in medical coding (ICD-10, CPT, HCPCS), benefit application, and compliance with California's Knox-Keene Act and Medi-Cal regulations. Training & Staff Development: Develop and deliver training for Claims Examiners, including creation of educational materials on workflows, policy updates, and new technologies. Research & Issue Resolution: Investigate complex claim issues, provider disputes, and appeals; identify root causes for systemic issues and recommend corrective actions. Reporting & Data Analysis: Track and report statistical data on MSO quality and production. Prepare regular reports for management. Regulatory Liaison: Maintain current knowledge of state and federal billing laws (CMS/Medicare) to ensure compliance and readiness for audits. **Other duties as assigned by senior management. If you are a detail-oriented detail oriented with experience in claim auditing, training, and regulatory compliance, we want to hear from you! Apply today and call us at (510) 470-7450 to take the next step in your career with Robert Half. Ready to make an impact? Apply now!
Key Responsibilities<br>• Lead and perform audits, reviews, and compilations in accordance with professional standards and firm policies.<br>• Plan engagement scope and timing, perform risk assessments, and design appropriate audit procedures.<br>• Prepare and review workpapers, ensuring proper documentation and support for conclusions.<br>• Oversee and execute audit procedures for nonprofit organizations, including grant and compliance areas as applicable.<br>• Perform assurance work for employee benefit/pension plans, including testing contributions, distributions, and investments.<br>• Work on affordable housing engagements, including low-income housing entities and related compliance matters.<br>• Assist with engagements for homeowners associations; prior HOA experience a plus.<br>• Draft and review financial statements, footnote disclosures, management letters, and internal control communications.<br>• Supervise, train, and mentor staff, providing clear instructions and timely feedback.<br>• Monitor engagement budgets and timelines; communicate status and issues to managers/partners.<br>• Identify accounting, auditing, and internal control issues, and propose practical solutions to clients.<br>• Assist with implementation of new accounting and auditing standards for assigned clients.<br>Qualifications<br>• Bachelor’s degree in accounting or related field required.<br>• CPA license preferred; candidates actively pursuing licensure considered.<br>• Minimum of 3 years of recent experience in public accounting with a focus on auditing and assurance.<br>• Experience with nonprofit organizations and/or employee benefit plans strongly preferred; affordable housing and HOA experience a plus.<br>• Solid knowledge of U.S. GAAP and generally accepted auditing standards.<br>• Proficiency with Microsoft Office and audit/engagement software.<br>• Strong analytical, organizational, and problem-solving skills.<br>• Effective written and verbal communication skills.<br>• Ability to manage multiple engagements and deadlines.<br>• Team-oriented with demonstrated leadership and supervisory abilities.