Claims Audit Analyst

Job Summary

A company is looking for a Claims Audit Analyst to ensure timely and accurate processing of claims while adhering to regulations and policies.

Key Responsibilities

• Review processed claims for accuracy prior to payment and maintain acceptable levels of claims aged inventory
• Document audit findings, including decision methodology, system errors, and monetary discrepancies
• Provide feedback on claims processing errors and quality improvement opportunities to the Oversight & Monitoring Manager

Required Qualifications

• Minimum of three (3) years of experience in processing and auditing Medicare and Medicaid claims
• Working knowledge of the health plan insurance industry, including CPT/HCPCS procedure codes and ICD-10 codes
• Experience with CMS and Medicaid healthcare claims is highly preferred
• Demonstrated proficiency in Microsoft Office Applications, particularly Excel