Claims Auditor

Job Summary

A company is looking for a Claims Auditor.

Key Responsibilities:

• Review claims for statistical and payment accuracy, ensuring correct payments or denials and use of adjustment or reason codes
• Identify root cause of errors and collaborate with internal departments for resolution
• Assist with training of claims examiners based on identified errors

Required Qualifications:

• 3+ years of medical claims auditing experience in HMO or IPA/Medical Group setting, preferably Medicare claims
• 5+ years of experience in examining all types of medical claims, preferably Medicare claims
• Experience working with Provider Dispute and Appeals
• Proficiency in Microsoft Office programs (Excel, Access, Word), intermediate level
• Experience using claims processing systems (EZCAP preferred)