Medical Claims Auditor

Job Summary

A company is looking for a Medical Claims Auditor.

Key Responsibilities

• Review claims for billing and coding issues to identify inaccuracies and potential fraud
• Identify control and audit opportunities to mitigate healthcare fraud, waste, and abuse
• Manage audit workload to ensure timely and accurate results while supporting provider discussions

Required Qualifications

• 3+ years of coding and auditing experience, with CMS regulations preferred
• Certified Professional Coder (CPC) or other coding certification is a plus
• Strong knowledge of National Rules of Correct Codification by CMS
• Experience in technology environments, including claims systems and workflow management tools
• Prior experience in health insurance, especially Medicare Advantage, is a plus