Claims Auditor

Job Summary

A company is looking for a Claims Auditor.

Key Responsibilities

• Perform pre-payment and post-payment audits for claims processing accuracy and compliance
• Audit and confirm the accuracy of fee schedules, provider contracts, payor contracts, and benefits
• Ensure accuracy in code changes and system enhancements related to claims

Required Qualifications

• High School Diploma or equivalent
• 5 years of experience in a medical claims processing environment
• Knowledge of HMO/managed care regulatory guidelines
• Experience with Epic Tapestry system preferred
• 3 years of experience in claim audits, revenue recovery, or claims system configuration preferred