Certified Medical Claims Auditor

Job Summary

As a Certified Medical Claims Auditor, the full-time remote position will review medical claims to identify billing discrepancies, collaborate with internal teams to resolve complex issues, and provide actionable insights to enhance client outcomes.

Key responsibilities

• Review medical bills for appropriate billing, coding, and savings opportunities
• Analyze and resolve claim discrepancies requiring advanced expertise
• Communicate findings to clients through detailed reports and assist with complex inquiries

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