Medical Auditor II

SAIF Corporation•Street, MD

3d•$56,325 - $93,875•Hybrid

About The Position

As a medical auditor for SAIF, you’ll work in a computerized, fast-paced production environment to ensure payments to medical providers are accurate and timely. A medical auditor does more than review medical bills and ensure correct payment amounts. You’ll serve as the primary point of contact for medical providers, claims adjusters, and other parties involved in medical bill payment. You will also be explaining payment amounts, answering their questions and explaining workers compensation rules. If you like working on a team in a fast-paced environment, and you know your way around medical bills, chart notes, and coding, we invite you to apply. Flexible workers may be required to travel to SAIF’s offices in Salem, Oregon.

Requirements

Three or more years of experience processing medical insurance billings and using medical terminology, ICD-10 and CPT codes.
High school graduation or equivalent education and completion of medical terminology and ICD-10/CPT code courses.
Other combinations of skills and experience may be considered.

Responsibilities

Review automated audit results and documentation and make adjustments to audit results when necessary to reflect correct payment amounts in accordance with accepted condition, policies, guidelines, coding standards and regulations.
Forward audit recommendation to claims adjuster for final review and payment determination or approve bills for payment based on claims adjuster direction, or guidelines.
Research medical audit and system issues and communicate this information with recommended actions to internal and external customers, including claims adjusters, medical providers, and MCOs.
Explain pertinent laws, rules, and policies, to internal and external customers, including claims adjusters, medical providers, and MCOs and how the policies impact audit recommendations.
Recognize services requiring complex review and forward to the designated resource for resolution.
Report unusual billing patterns to supervisor for assessment, follow up and referral to the Investigations unit when applicable.
Requests refunds from providers when overpayments occur.
Process prescription drug authorizations and billings through pharmacy benefit on-line system, using knowledge of standard pharmacy codes and SAIF’s policies.
Communicate with claims adjusters and pharmacies regarding issues related to processing drug prescriptions.
Explore diverse perspectives and consistently behave sensitively toward differences in cultural norms, expectations, and ways of communicating.
Work effectively with others who have different perspectives, backgrounds, and/or work styles.
Continually sustain the Inclusive Leadership Competencies (ILC) through the Explorer level on an annual basis.