MARCH® Vision Care is committed to being an active partner in improving the overall health of members through better vision care. We are dedicated to providing quality vision care that focuses on early disease detection, education, and management using innovative, member-oriented solutions.

MARCH® Vision Care, located California, is a vision benefit plan that serves members nationwide.

**The Targeted Start Date for this Position is February 2017**

Responds to comprehensive delegated audits across all states. Prepares audit universes and ensures supporting documentation is complete and accurate for claims processing, customer services, provider rosters, provider contracting and credentialing. Develops and implements corrective action plans in collaboration with business SMEs in order to remediate deficiencies and key findings.

• Keeps track of Payer Audits in a designated spreadsheet and stores all audit related documents in individual client folders.
• Coordinates with the Credentialing Department to keep track and document their credentialing audits in the Payor Audit Folder.
  

• Reviews, analyzes, and seeks clarification on universe requests received from clients. 
  

• Submits universe requests through the ticket system and reviews them before delivery to ensure it meets the requested requirements.
  

• Forwards Call Center universe requests and call selections to the manager of Customer Service for processing.
  

• Completes audit questionnaires.
  

• Gathers all information pertaining to selected claims for audit and delivers them to the clients through secured emails, ftp sites, hard copy disks, or in any other way specified by the client.
  

• Queries and extracts data from various databases, using various tools including SQL, with an understanding of broad data content available and specific table structures as part of the universe data accuracy verification.
  

• Documents, stores, and forwards audits findings to the Director of QAR.

• All other duties as assigned by management.

Level of Education:

• High school diploma or equivalent. Bachelor degree preferred.

Level of Experience:

• 5+ years of claims auditing experience for all claim types, with solid knowledge of CMS Regulatory Prompt Pay Guidelines.

• 2+ years of experience with Microsoft Office (Word, Outlook, Excel, and PowerPoint) in an intermediate level of proficiency for data analysis and validation.

• 2+ years of experience in performing oversight of claims processing activities for vendors, delegated groups, etc.

• Thorough working knowledge of ICD9 coding, CPT4 coding, HCPCS coding, CMS (HCFA DMHC/DOI guidelines and medical terminology.

• Fundamental understanding of claims and customer service delegation audit procedures and protocol.

• Fundamental understanding of industry standard Managed Care Operations reporting practices.

• Relational database / MS SQL / Crystal Reports experience.

• Proficient in querying a large amount of data using SQL query skills.

Do you possess the strategic, conceptual and creative thinking skills necessary to out-perform your job description? If you have an open mind and a true passion for our organization's mission and can execute numerous projects simultaneously under deadline pressure, MARCH VISION CARE, a rapidly growing health care provider located in West Los Angeles, offers the daily rewards and challenges associated with a fast-paced, cutting-edge organization.  We offer a pleasant working environment and a competitive compensation/benefits package.  Take advantage of a great location and pleasant team atmosphere that fosters creativity, where your input can have a profound effect.  Are you ready to become a part of the MARCH success?

For consideration please visit our website at www.marchvisioncare.com, select the position you are interested in, and click "I'm Interested" and upload an up-to-date version of your resume.

Internal candidates should also follow-up with the Human Resources department.

March Vision Care, Inc. is an equal opportunity employer who employs individuals based on job-related qualifications regardless of race, religion, sex, national origin, age, disabilities, or any basis prohibited by law. Our business supports a drug free work environment, which requires pre-employment drug screening. We also conduct thorough background investigations and all positions require skill assessment tests. March Vision Care, Inc. is regulated by federal and state requirements, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the California Confidentiality of Medical Information Act (CMIA). All positions have an individual and company role and responsibility to maintain compliance with all applicable regulations.