Certified Medical Claims Auditor
Job Summary
To support a growing healthcare organization, the full-time Certified Medical Claims Auditor will review medical claims for billing discrepancies, analyze complex issues, and collaborate with internal teams to identify savings opportunities, all while working remotely.
Key responsibilities:
- Review medical bills to identify appropriate billing, coding, and savings opportunities
- Analyze and resolve claim discrepancies that require advanced expertise
- Communicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiries
Required qualifications:
- 3+ years of auditing, claims review, and/or billing experience within a healthcare organization
- Active CPC and/or CIC certification
- Working knowledge of industry coding, including ICD-10, CPT, and HCPCS Revenue codes
- Knowledge of CMS guidelines
- Experience in DRG validation is a plus
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