Medicare Audit Specialist

Job Summary

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

Key Responsibilities

• Review complex claims and patient records to identify discrepancies in payments to Medicare providers
• Prepare complex claims reimbursement submissions and serve as an advocate for clinic administration on reimbursement issues
• Conduct internal and external data reviews to ensure compliance with CMS guidelines and medical policies

Required Qualifications

• High school education or equivalent with 6 years of experience in payor policies and reimbursement
• Bachelor's degree preferred
• Licensed Medicare auditor or Certified Medical Audit Specialist preferred
• High level knowledge of Medicare audit, appeals, and reimbursement processes
• Experience with Electronic Health Records (EHR) and MS Office suite programs