Claims Auditor
New
Bangladesh, Cameroon, Ghana, India, Nepal, Nigeria, Pakistan, Sri Lanka, United Kingdom, United StatesFull-TimeMiddle
Salary36,400 - 58,240 USD per year
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Job Details
- Experience
- Three years of experience related to health insurance claim processing required. Three years of experience related to CPT/HCPCS and current ICD coding.
- Required Skills
- Data AnalysisMicrosoft Office Suite
Requirements
- High school diploma or equivalent.
- Three years of experience in health insurance claim processing.
- Three years of experience with CPT/HCPCS and ICD coding.
- Working knowledge of anatomy and physiology.
- Proficiency with Microsoft Office Suite.
- Demonstrated analytical and problem-solving skills.
- Demonstrated written and oral communication skills.
- Completion of CPT, ICD, HCPCS, and medical terminology courses (required within 1 year).
- Associates degree in business, medical or related field (preferred).
- One year of experience in claims auditing (preferred).
- Certified Professional Coder (CPC) or CPC-P certification (preferred).
Responsibilities
- Perform payment, procedural accuracy, compliance, and operational audits on claims.
- Apply audit procedures to collect, analyze, and report concise findings.
- Develop and maintain knowledge of CPT, ICD, HCPCS, and CMS reimbursement guidelines.
- Utilize plan documents to verify appropriate claim benefit application.
- Conduct monthly audits of pre-pay and post-paid claims.
- Investigate and report claim variances for correction.
- Perform focused or ad-hoc audits as needed.
- Review medical records to determine appropriateness of charges.
- Analyze and resolve complex claim processing problems.
- Analyze claim errors and provide reports to management to improve processes.
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