Certified Medical Claims Auditor

Job Summary

To support accurate payment and operational efficiencies, the full-time hourly Certified Medical Claims Auditor will review professional and facility claims for compliance with coding guidelines and contractual language while working remotely.

Key responsibilities

• Review professional and facility claims for accuracy, applying standard coding rules and guidelines
• Analyze medical records and itemized bills to validate the appropriateness of billing and coding procedures
• Audit codes and services performed by providers according to ICD-10, CPT, HCPCS, and CMS guidelines

Required qualifications

• High School Diploma or equivalent required
• Minimum 2 years of Claims Coding or Medical Billing experience required
• Coding Certification (CPC, CCA, CCS, RHIA, etc.) and/or Nursing Licensure (RN, LPN, etc.) required
• Medicare Reimbursement/Demotion experience preferred
• Proficiency in coding guidelines and reimbursement methodologies for all types of services