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American Health Partners

Claims Auditor

Franklin, TN · Hybrid

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care ...

American Health Partners

Claims Auditor

Franklin, TN · On-site

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care ...

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What is it like to work at American Health Partners?

American Health Partners is a healthcare organization that prioritizes patient-centered care and community involvement, fostering a collaborative and compassionate work environment.

The company's team structure is designed to promote interdisciplinary collaboration, with healthcare professionals working together to provide comprehensive care to patients. American Health Partners operates multiple medical facilities and clinics, offering a range of medical services and specialties.

Working at American Health Partners may appeal to individuals who are passionate about delivering high-quality patient care and contributing to the well-being of their local community, with opportunities for professional growth and development in a dynamic and supportive team.

What makes American Health Partners an attractive place to work?

American Health Partners is a leading healthcare organization that prioritizes delivering high-quality patient care and advancing medical innovation. The company fosters a collaborative work environment that encourages teamwork, open communication, and professional growth, with opportunities for employees to develop their skills and expertise. By joining American Health Partners, individuals can contribute to the organization's mission of improving healthcare outcomes and make a meaningful impact in their community.

What are the most popular titles at American Health Partners?

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Infographic showing various job openings at American Health Partners in the United States as of August 2026, with employment types broken down into 78% Full Time, and 22% Part Time. Highlights an 88% Physical, 4% Hybrid, and 8% Remote job distribution.

Claims Auditor

American Health Partners

Franklin, TN • Hybrid

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 26 days ago

Key responsibilities

  • Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials

  • Work closely with delegated claim processor to review and correct errors prior to final payment

  • Participate in and support ad-hoc audits as needed

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. 

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! 

Benefits and Perks include:

  • Affordable Medical/Dental/Vision insurance options
  • Generous paid time-off program and paid holidays for full time staff
  • TeleMedicine 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts
  • Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. 

  • Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
  • Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
  • Work assigned claim projects to completion
  • Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
  • Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
  • Maintain production and quality standards as established by management
  • Participate in and support ad-hoc audits as needed
  • Other duties as assigned

JOB REQUIREMENTS:

  • Proficient in processing/auditing claims for Medicare and Medicaid plans
  • Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
  • Current experience with both Institutional and Professional claim payments
  • Knowledge of automated claims processing systems
  • Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:

  • Experience:
    • Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
    • Two (2) years’ experience in managed healthcare environment related to claims processing/audit
    • Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
    • Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
    • Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
  • License/Certification(s):
    • Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

 This employer participates in E-Verify.

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About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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