Licensed Medicare Audit Specialist

Job Summary

A company is looking for a Priority Claims Specialist IV - Remote.

Key Responsibilities

• Review complex claims and patient records, identifying discrepancies in payments to Medicare providers
• Prepare complex claims reimbursement submissions and serve as an advocate for clinic administration regarding reimbursement issues
• Conduct analytical research on pricing, reimbursement, and claim appeals processes while maintaining relationships with insurance organizations

Required Qualifications

• High school education or equivalent
• 6 years of experience with payor policies, reimbursement, and medical policy
• Bachelor's degree preferred
• Licensed Medicare auditor or Certified Medical Audit Specialist preferred
• High-level knowledge of Medicare audit, appeals, and reimbursement processes