Health Plan Medical Claims Auditor - Remote | WFH - Get It Recruit - Healthcare
Phoenix, AZ 85003
About the Job
We are a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Our mission is to enhance engagement and satisfaction with plans' members and providers through our comprehensive suite of services, including claims processing, digital transformation, and member and provider engagement solutions. With headquarters in Tampa and regional offices across the U.S., we are dedicated to delivering high-quality support to our clients while fostering a collaborative and rewarding work environment for our team members.
Position Overview:
We are currently seeking a detail-oriented and experienced Medical Claims Auditor to join our team. As a Medical Claims Auditor, you will play a crucial role in ensuring the accuracy, compliance, and adherence to company policies and procedures in the processing of medical claims. You will collaborate closely with our claims processing team to identify discrepancies, resolve issues, and continuously improve the overall accuracy of claims submissions.
Key Responsibilities:
Conduct audits of medical claims to verify accuracy, completeness, and compliance with regulatory requirements.
Review claim documentation, including medical records and billing codes, to ensure proper coding and billing practices.
Identify errors, discrepancies, and potential fraud or abuse in claims submissions.
Investigate and resolve discrepancies through effective communication with internal departments and clients.
Collaborate with the claims processing team to implement process improvements and ensure consistent adherence to company policies and procedures.
Prepare comprehensive audit reports detailing findings, recommendations, and corrective actions taken.
Stay updated with industry regulations, coding guidelines, and best practices related to medical claims processing and auditing.
Qualifications:
Bachelor's degree or equivalent experience in healthcare administration, business administration, or a related field.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification preferred.
Minimum of 5 years of experience in medical claims processing, billing, or auditing.
Strong understanding of medical terminology, ICD-10, CPT, and HCPCS coding systems.
Knowledge of healthcare regulations, including HIPAA, Medicare, and Medicaid guidelines.
Excellent analytical and problem-solving skills with meticulous attention to detail.
Effective communication skills, both verbal and written, with the ability to convey complex information clearly and concisely.
Proficiency in Microsoft Office applications, especially Excel, and experience with claims processing software preferred.
Equal Opportunity Employer:
We are committed to providing equal employment opportunities to all employees and applicants for employment. We prohibit discrimination and harassment of any type based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This commitment extends to all aspects of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 18.00 22.00 Per Hour
Position Overview:
We are currently seeking a detail-oriented and experienced Medical Claims Auditor to join our team. As a Medical Claims Auditor, you will play a crucial role in ensuring the accuracy, compliance, and adherence to company policies and procedures in the processing of medical claims. You will collaborate closely with our claims processing team to identify discrepancies, resolve issues, and continuously improve the overall accuracy of claims submissions.
Key Responsibilities:
Conduct audits of medical claims to verify accuracy, completeness, and compliance with regulatory requirements.
Review claim documentation, including medical records and billing codes, to ensure proper coding and billing practices.
Identify errors, discrepancies, and potential fraud or abuse in claims submissions.
Investigate and resolve discrepancies through effective communication with internal departments and clients.
Collaborate with the claims processing team to implement process improvements and ensure consistent adherence to company policies and procedures.
Prepare comprehensive audit reports detailing findings, recommendations, and corrective actions taken.
Stay updated with industry regulations, coding guidelines, and best practices related to medical claims processing and auditing.
Qualifications:
Bachelor's degree or equivalent experience in healthcare administration, business administration, or a related field.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification preferred.
Minimum of 5 years of experience in medical claims processing, billing, or auditing.
Strong understanding of medical terminology, ICD-10, CPT, and HCPCS coding systems.
Knowledge of healthcare regulations, including HIPAA, Medicare, and Medicaid guidelines.
Excellent analytical and problem-solving skills with meticulous attention to detail.
Effective communication skills, both verbal and written, with the ability to convey complex information clearly and concisely.
Proficiency in Microsoft Office applications, especially Excel, and experience with claims processing software preferred.
Equal Opportunity Employer:
We are committed to providing equal employment opportunities to all employees and applicants for employment. We prohibit discrimination and harassment of any type based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This commitment extends to all aspects of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 18.00 22.00 Per Hour
Source : Get It Recruit - Healthcare