Lead Payment Integrity Auditor

Job Summary

Providing critical oversight and support in quality claim audits, the full-time Lead Payment Integrity Auditor will ensure compliance with company standards, assist in recovery efforts, and deliver training and reporting for the Claims Department in a remote work environment.

Key responsibilities

• Conduct in-depth audits of medical, dental, and vision claims to ensure payment integrity and regulatory compliance
• Identify and escalate issues related to claims procedures and enhance Payment Integrity guidelines and workflows
• Provide training and support to new hires and existing staff on complex claims topics and processes

Required qualifications

• High school diploma or equivalent with 4-6 years of experience as a claims auditor, preferably in medical, dental, and vision claims
• Strong knowledge of CPT, ICD-10, and medical terminology, along with revenue and receivables operations
• Understanding of CMS, HIPAA, MEWA, ERISA regulations, and compliance standards
• Experience with electronic data interchange (EDI) transactions, specifically 835 and 837 files, is preferred
• Proficient in end-user software, including word-processing and spreadsheet applications