Provider Reimbursement Auditor

Job Summary

Performing comprehensive audits of provider claims, the full-time Provider Reimbursement Auditor will analyze errors, validate audit observations, and ensure compliance with policies while working remotely.

Key responsibilities

• Conduct quality audits of provider claims using various sources of information
• Analyze errors to determine root causes and assign appropriate responses
• Utilize audit software to document observations and validate responses for accuracy

Required qualifications

• Associate's degree in a related field or equivalent experience
• 2+ years of medical or pharmacy claims processing or claims pricing experience
• Knowledge of Medicaid and Medicare reimbursement rules
• Familiarity with CPT/HCPCS Coding preferred
• Strong Excel skills and experience working remotely