Claims Auditor

Job Summary

Performing various audits of claims payments and denials, the full-time Claims Auditor will ensure accuracy and regulatory compliance while working remotely.

Key responsibilities

• Conduct pre-pay and post-pay audits to verify claims payments and denials
• Utilize knowledge of claims processing standards to ensure quality and efficiency
• Collaborate with the Claims Department to identify and correct processing errors before final payment

Required qualifications

• Associate's degree preferred or equivalent experience
• 3+ years of complex claims processing and/or auditing experience in a health plan or managed care organization
• Proficient in processing/auditing claims for Medicare and Medicaid plans
• Strong knowledge of CMS requirements and standard coding materials such as CPT4, ICD9, ICD10, and DRG
• Current experience in both Institutional and Professional claim payment