Claims Auditor

Marshfield Clinic • Marshfield, WI

147d

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.
• 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.

Nice To Haves

• Associate degree in business, medical or related field.
• 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

• Perform payment, procedural accuracy, turnaround time, compliance and operational audits as directed by management.
• Apply effective, appropriate and efficient audit procedures in collecting, analyzing and reporting findings.

What This Job Offers

• Job Type: Full-time
• Industry: Professional, Scientific, and Technical Services
• Education Level: High school or GED