Job Description
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Role Description
- The Medical Auditor is responsible for auditing medical facilities and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients.
- Review medical facility and professional claims for accuracy and apply standard coding rules, guidelines and conventions
- Enter billing information into the appropriate report format for the client requesting the work
- Review contracts and apply contractual adjustments to the medical charges
- Audit charges for CPT coding and compliance with state and federal regulations
- Process and access coding patterns and identify signs of fraud and abuse
- Review medical records to verify accurate coding
- Ensure accuracy of work product
- Proficient in meeting quality and quantity standards
- Able to learn and properly utilize proprietary software programs essential to support the job function
- Adhere to HIPAA guidelines and regulations
- Perform additional duties assigned by management
- Qualifications
- High School Diploma or equivalent
- Minimum 2 years Claims Coding or Medical Billing experience
- Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms
- Medicare Reimbursement / Denial experience preferred
- AAPC Certification and ICD-10 Proficient is required
- Prior experience in the Self-Funded Industry is desired
- Benefits
- Multiple Health Plan Options
- Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance
- Parental Leave Policy
- 20 days PTO to start / 10 Paid Holidays
- Tuition reimbursement
- 401k Company contribution
- Professional development initiatives / continuous learning opportunities
- Opportunities to participate in and support the company's diversity and inclusion initiatives
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