Oregon Licensed Medical Auditor

Job Summary

Working remotely or in a hybrid environment, the full-time Oregon Licensed Medical Auditor will review automated audit results, communicate with medical providers and claims adjusters, and ensure accurate payments for medical services while adhering to relevant regulations and guidelines.

Key responsibilities:

• Review and adjust automated audit results to ensure accurate payment amounts according to policies and coding standards
• Research and communicate medical audit issues and explain relevant laws and policies to internal and external stakeholders
• Process prescription drug authorizations and billings, resolving issues with claims adjusters and pharmacies

Required qualifications:

• Three or more years of experience in processing medical insurance billings with knowledge of medical terminology, ICD-10, and CPT codes
• High school diploma or equivalent education, including completion of medical terminology and ICD-10/CPT code courses
• Other combinations of skills and experience may be considered