Claims Auditor Jobs

About The Position

Requirements

• Two years of experience with complex claims processing and/or auditing in the health insurance industry or medical health care delivery system.
• Two years of experience in a managed healthcare environment related to claims processing or audit.
• Two years of experience with standard coding and reference materials used in a claims setting, such as CPT4, ICD10, and HCPCS.
• Two years of experience with CMS requirements for claims processing, especially Skilled Nursing Facility and other complex claim processing rules and regulations.
• Two years of experience processing or auditing claims for Medicare and Medicaid plans.
• Proficiency in processing and auditing claims for Medicare and Medicaid plans.
• Strong knowledge of CMS claims processing requirements, particularly for skilled nursing facilities and other complex claims.
• Current experience with both Institutional and Professional claim payments.
• Knowledge of automated claims processing systems.

Nice To Haves

• Coding certification preferred.

Responsibilities

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

Benefits

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