High Cost Drug Auditor

Job Summary

Working remotely, the full-time High Cost Drug Auditor III will conduct extensive audit reviews of high cost drug claims, utilizing HCPCS codes and medical record analysis to identify discrepancies and document findings effectively.

Key responsibilities

• Conduct HCPCS coding reviews to verify accuracy of coding assignments and reimbursement on claims
• Perform complex medical record reviews to identify discrepancies between physician orders and final claims submissions
• Document audit results clearly and concisely using AMA Guidelines while meeting established productivity and quality goals

Required qualifications

• Three or more years of experience in claims processing or high cost drug medical billing with expert knowledge of HCPCS codes
• Experience in reading and interpreting contract language, fee schedules, and conducting medical record reviews
• Intermediate skills in Word and Excel, including comfort with charts and basic math calculations
• High school diploma or equivalent