Auditor - Credit Balance Recovery

Date: Nov 17, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5177 


Position Summary/Position


Under the direction of the Provider Claims Resolution & Recovery Manager, the Credit Balance Recovery Auditor is responsible for pursuing credit balance recoveries, reviewing and auditing the payment and handling all aspects of the credit balance recovery process from initial contact with the facilities through accounts receivable follow-up and resolution.

Major Functions (Duties and Responsibilities)


1. Initiate contact and outgoing communication with facilities by telephone and in writing to accept/receive refunds for overpayments.
2. Review, audit and validate the accuracy of the claim payment.
3. Review, research and resolve accounts in a credit balance to bring final resolution.
4. Perform root cause analysis of the overpayments.
5. Identify and analyze trends and provide reporting, as necessary.
6. Perform accounts receivable follow up and resolution.
7. Establish professional working relationships to ensure operational efficiency.
8. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
9. Promote teamwork and maintain effective working relationships with others throughout the organization.

Supervisory Responsibilities

Leading: Self

Experience Qualifications


Three (3) years recovery and resolution experience. Two (2) years of experience auditing Medicare and Medi-Cal claims in a managed care environment including contract and financial DOFR interpretation. Healthcare finance experience with a focus on auditing and analysis. Experience with MS Office applications. Have experience reviewing contracts and auditing claims to ensure payment/settlements are in compliance with State and Federal regulations as well as processing standards established by IEHP.

Preferred Experience

Education Qualifications


High school diploma or GED required.

Preferred Education


Bachelor’s degree from an accredited institution preferred.

Professional Certification

Professional Licenses

Drivers License Required


Knowledge Requirement


Knowledge of Medi-Cal and CMS guidelines for claim payments.

Skills Requirement


Strong analytical and problem-solving skills. Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings. Microsoft Office including being able to manipulate large data sets in Excel files.  Excellent oral and written communication skills.

Abilities Requirement


Ability to build successful relationships across the organization. 

Commitment to Team Culture


The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions


Sedentary work in an office environment.

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Other - FREQUENTLY
Use of computer mouse - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Hearing: In a group - FREQUENTLY
Hearing: Over the Telephone/Cell Phone - FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Turning/rotation of wrist or hand - FREQUENTLY
Alternate Sit/Stand or Walk at Will - FREQUENTLY
Perform complex and varied tasks - FREQUENTLY
Develop and maintain positive work relationships - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Decision-making - FREQUENTLY
Lead/Influence Others - FREQUENTLY
Work review - FREQUENTLY
Rapid Pace of work - FREQUENTLY
Control of work pace - FREQUENTLY
Problem Solving - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY


Starting Salary: $50,835.20  - $64,792.00  

Pay rate will commensurate with experience


Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles