Remote Medical Claims Auditor

Job Summary

A company is looking for a Remote Medical Claims Processor Auditor.

Key Responsibilities

• Conduct routine monitoring and audits of procedures related to claims processing
• Ensure compliance with client contract criteria and generate required claims reporting
• Assist in preparing for annual Health Plan audits and monitor processes for fraud detection

Required Qualifications

• 3-5 years of experience in the healthcare or managed care industry, including claims/reimbursement experience
• 3 years of auditing experience in the healthcare industry
• Knowledge of CPT and ICD coding, Medicare requirements, and APC Pricing
• Advanced proficiency in Microsoft Office products, especially Excel and Access
• Understanding of federal, state, and local healthcare compliance requirements