Claims Auditor

Job Summary

A company is looking for a Claims Auditor.

Key Responsibilities

• Conduct pre-check run auditing on various reports prior to finalizing the check run, managing timelines effectively
• Assist with Health Plan claim audits and provide feedback to management and staff regarding results
• Complete Claims Appeals and 095 processes according to health plan and company guidelines within established timeframes

Required Qualifications

• Bachelor's degree or equivalent experience required
• 4-5 years of experience in claim processing
• Specific knowledge of claims and processes in a Commercial BC/BS HMO organization
• Extensive knowledge of CPT 4, HCPCS, UB-04, and ICD-10 coding
• Medical terminology knowledge