We are looking for a meticulous and seasoned Medical Claims Auditor to join our team. As a Medical Claims Auditor, you will play a crucial role in ensuring the accuracy and compliance of medical claims processing while adhering to company standards and regulatory requirements.
Key ResponsibilitiesConduct thorough audits of medical claims to ensure accuracy, completeness, and compliance with regulatory standards.
Review claim documentation, including medical records and billing codes, to verify proper coding and billing practices.
Identify discrepancies, errors, and potential instances of fraud or abuse in claim submissions.
Investigate and resolve discrepancies through collaboration with internal teams and external stakeholders.
Work closely with the claims processing team to implement process improvements and maintain adherence to company policies.
Prepare detailed audit reports outlining findings, recommendations, and actions taken to address issues.
Stay updated on industry regulations, coding guidelines, and best practices related to medical claims processing and auditing.
QualificationsBachelor's degree in healthcare administration, business administration, or a related field; or equivalent work experience.
Preferred certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
Minimum of 5 years of experience in medical claims processing, billing, or auditing.
Strong proficiency in medical terminology, ICD-10, CPT, and HCPCS coding systems.
Thorough knowledge of healthcare regulations including HIPAA, Medicare, and Medicaid guidelines.
Exceptional analytical and problem-solving abilities with a meticulous attention to detail.
Effective communication skills, both verbal and written, to articulate complex information clearly.
Proficiency in Microsoft Office applications, particularly Excel; experience with claims processing software is advantageous.
Employment Type: Full-Time