Third Party Claims Reviewer

Job Summary

Conducting thorough reviews of healthcare billing and claims documentation, the full-time remote Third Party Claims Reviewer will ensure accuracy, compliance with regulations, and collaborate with healthcare providers to resolve discrepancies.

Key responsibilities

• Review medical claims and billing documentation for accuracy and compliance with coding guidelines and payer policies
• Identify potential compliance issues and conduct audits to ensure adherence to industry regulations
• Analyze claim denials and recommend corrective actions to prevent future issues

Required qualifications

• High School Diploma or Equivalent required
• Experience in medical billing, claims processing, or coding within a healthcare environment, with a focus on third-party payer guidelines
• 1-2 years of related experience highly preferred
• In-depth knowledge of coding systems (e.g., ICD-10-CM, CPT, HCPCS) and billing compliance regulations
• Proficiency in using billing software and electronic health record (EHR) systems