Medical Claims Auditor
Point C
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Salary
💰 $19 - $25 per hour
About the role
- Review and audit medical claims for accuracy and compliance with company policies and benefit plan parameters.
- Listen to customer service phone calls for accuracy and professionalism.
- Provide feedback, coaching, and mentoring to claims and customer service staff members on results, best practices and compliance issues.
- Assist in training efforts as needed.
- Prepare summary and detailed reports on audit findings, trends, and recommendations for process enhancements.
- Stay updated on industry changes in medical coding, billing regulations, and insurance policies.
- Assist in developing and implementing audit policies and procedures.
- Measure and report on performance guarantee results.
Requirements
- Minimum of 2 years of experience in customer service or claims processing, preferably within the healthcare or employee benefits industry. Experience with self-funded plans and TPAs is highly desirable.
- Written and Oral Communication Skills: Proven ability to respond to internal customers in a professional, accurate and thorough manner.
- Benefits Expertise: Strong knowledge of benefits plan design and auditing processes as well as medical terminology, ICD-10 and CPT coding.
- Detail-Oriented: Exceptional attention to detail and accuracy in all aspects of research, problem solving and communication.
- Problem-Solving Skills: Ability to analyze issues, identify root causes, and work with management to implement effective solutions in a timely manner.
Benefits
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
- Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical claims auditingICD-10 codingCPT codingbenefits plan designclaims processingreport preparationcompliance auditingperformance measurement
Soft Skills
communication skillscoachingmentoringattention to detailproblem-solving