Medical Claims Auditor (Remote - Texas)

Gainwell Technologies LLC • OH

80d • $30,500 - $42,500

About The Position

The Medical Claims Auditor is responsible for reviewing and analyzing medical claims to ensure accuracy, compliance, and adherence to company and regulatory standards. This role involves auditing provider-submitted claims, validating coding accuracy, and identifying errors or discrepancies in claim submissions. The ideal candidate has strong attention to detail, a solid understanding of medical billing and coding, and experience with appeals or reimbursement processes in a healthcare or hospital setting.

Requirements

• Minimum of 3 years of experience handling appeal claims in a hospital or healthcare setting.
• Ability to interpret EOBs and UB-04 claim forms required.
• Working knowledge of ICD-10, CPT, HCPCS, DSM-IV, and CMS-1500 forms preferred.
• Certification in medical coding (CPC, CCS, or equivalent) strongly preferred.
• Strong analytical and problem-solving skills with high attention to detail.
• Proficiency in Microsoft Office applications, particularly Excel and Word.
• Excellent communication skills and ability to work effectively in a remote environment.

Responsibilities

• Review medical claims, supporting documentation, and medical records to ensure completeness, accuracy, and compliance with company policies and industry standards.
• Validate coding accuracy using ICD-10, CPT, and HCPCS guidelines.
• Interpret and analyze Explanation of Benefits (EOB) and UB-04 claim forms to verify correct billing and payment data.
• Identify and document discrepancies such as duplicate claims, unbundled services, upcoding, and other billing errors.
• Communicate audit findings and recommend corrective actions to the claims processing team or management.
• Apply auditing methodologies and regulatory guidelines (CMS, Medicaid, Medicare, and payer contracts) to ensure claims integrity.
• Support process improvements to enhance claim accuracy and reduce billing errors.

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees