Claims Auditor (Remote - WI or MN)

Marshfield Clinic Health System • Marshfield, WI

3d • Remote

About The Position

The Claims Auditor is responsible for performing payment, procedural accuracy, turnaround time, compliance and operational audits as directed by management. The Claims Auditor has working knowledge of the overall aspects of claim processing, both in and outside of Security Health Plan. Audit responsibilities include applying effective, appropriate and efficient audit procedures in collecting, analyzing and reporting concise and relevant findings.

Requirements

• High school diploma or equivalent.
• Successful completion of the following courses per departmental procedures, within one year of hire: current procedural terminology (CPT), current international classification of diseases (ICD), health care procedure coding system (HCPCS) and medical terminology.
• Three years’ experience related to health insurance claim processing.
• Three years’ experience related to CPT/HCPCS and current ICD coding.
• Demonstrated proficiency with analytical problem solving, written and oral communications and the Microsoft Office Suite.
• Working knowledge of anatomy & physiology.
• Certified Professional Coder (CPC) or Certified Professional Coder – Payer (CPC-P) certification awarded by the American Academy of Professional Coders (AAPC) within three years of hire based on the department position the resides in.
• Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment.
• Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Nice To Haves

• Associate degree in business, medical or related field.
• Successful completion of the following courses per departmental procedures at time of hire: current procedural terminology (CPT), current international classification of diseases (ICD), health care procedure coding system (HCPCS) and medical terminology.
• One year experience in claims auditing.
• Certified Professional Coder (CPC) or Certified Professional Coder – Payer (CPC-P) certification awarded by the American Academy of Professional Coders (AAPC) at time of hire.

Responsibilities

• performing payment, procedural accuracy, turnaround time, compliance and operational audits as directed by management
• applying effective, appropriate and efficient audit procedures in collecting, analyzing and reporting concise and relevant findings

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees