As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

• This position is responsible for auditing claims and customer service calls for UUHP.
• The Claims and Customer Service Auditor reviews claims for processing accuracy in accordance with the benefit plan and contract information.
• The incumbent also audits customer service calls for demonstrated empathy, advocacy, and expertise.
• This position is not responsible for providing care to patients.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

• Supports and promotes UUHP's mission, vision, values, and goals.
• Contributes to a positive and productive team environment.
• Performs routine and complex audits on phone calls and claims adjudication.
• Researches claim processing problems and errors to determine their origin and appropriate resolution. Summarizes those findings in reports for management.
• Ensures proper adjudication policies and procedures were followed as well as proper customer service expectations.
• Processes claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
• Provides prompt customer service to members, providers, billing departments, and other insurance companies regarding claims.
• Documents phone calls in system and follows up on issues if needed.

Knowledge / Skills / Abilities

• Demonstrates strong communication skills.

• Ability to perform the essential functions of the job as outlined above.

• Experience with claims processing in a health care delivery setting or insurance payer.

• Demonstrated skills in customer service.

• Ability to work effectively, independently, and as part of a team.

• Strong organization, time management and project management skills and multi-tasking abilities.

• Detail oriented with problem-solving abilities.

Qualifications

Required

• Associate's degree in Health Care Administration, Business, or the equivalency.
• Three years of experience collecting, organizing and maintaining health insurance and processing medical claims, enrollment, and familiarity with medical coding, or experience as a medical claim processor.

Preferred

• Extensive Customer Service experience in health care or insurance payer setting as the candidate's primary role will be auditing inbound customer service calls.
• Claims processing knowledge in a health care delivery or insurance payer setting.
• Knowledge of and experience with Medicaid, Medicare, and commercial insurance.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.