QUALITY CONTROL ANALYST

Cap Management Systems(CMS), a division of Tenet Health Systems is involved in the medical and administrative management of physician organizations, IPAs and medical groups who provide clinical services for health plan (HMO) members.

CMS is seeking to fill the following full-time position at our Encino location:

Quality Control Analyst – Audits daily professional and facility claims to identify examiner and system errors, as well as research and resolve the identified errors. Performs monthly audits identifying overpayments, underpayments and system errors.
REQUIREMENTS
Must be a team player with excellent verbal and written communication skills. This position entails heavy phone and PC usage, requires a strong knowledge of MS Word and Excel.
A minimum of 5 years experience in professional and institutional healthcare claims examining and three years auditing experience is required. Must be well versed in DOFR’s with contracted health plans and understand all types of fee schedules, including risk pools. Must have a strong knowledge and understanding of Managed Healthcare with excellent knowledge of CPT, RBRVS, DRG’s and ICD-9 coding and laws.