Certified Medical Claims Auditor

Job Summary

Reviewing medical claims for discrepancies, the full-time Certified Medical Claims Auditor will analyze billing practices, collaborate with teams to resolve complex issues, and communicate findings to clients in a fully remote environment.

Key responsibilities

• Review medical bills to identify billing, coding, and savings opportunities
• Analyze and resolve claim discrepancies requiring advanced expertise
• Collaborate with internal teams to implement process efficiencies and improve client satisfaction

Required qualifications

• 3+ years of auditing, claims review, and/or billing experience in a healthcare organization
• CPC and/or CIC certification
• Working knowledge of industry coding, including ICD-10, CPT, and HCPCS Revenue codes
• Knowledge of CMS guidelines
• Experience with DRG validation is a plus