Claims Compliance Auditor

Claims Compliance Auditor - FULLY REMOTE POSITION

Medix Healthcare

FULLY REMOTE

Schedule:

• Monday-Friday 8am-5pm (Flexible with Time Zones)

$75.00 - 95.00 Hourly - FULL TIME

Job Details

Hourly

$75.00 - 95.00 Hourly - FULL TIME

Job Type

Full-Time

Qualifications

• Significant health care claims experience and health claims rev cycle
• Familiarity with EDI files
• Knowledge of CORE standards (837/835s)
• CCS Certified (Inpatient/outpatient) or CPC with Facility (837I) experience
• Coding Expertise (inpatient/outpatient), assignment of benefits)
• CPT/HCPCS/ICD-10/Revenue Codes
• Knowledge of NUCC/NUBC
• X-12 CARC/RARC Claims adjustment reason code knowledge
• NCPDP Claims (Retail Pharmacy & DME)

Benefits

For your Health...

• Medical, Dental, and Vision Insurance
• Employer-Paid Basic Life Insurance/AD&D
• Voluntary Employee-Paid Life Insurance/AD&D
• Employer-Paid Short Term and Long Term Disability
• Employee Assistance Program
• Wellness Program

For your Wealth...

• HSA and FSA Options
• 401k Retirement Plan with Company Match

For your Wealth...

• Paid Time Off
• Travel Assistance Program

Full Job Description

Are you looking to advance your career in healthcare? We are currenting hiring for a FULLY REMOTE Claims Compliance Auditor in the United States to support a large TPA organization. Apply to get your name in the mix and join our industry movement!

What we provide to you as a full-time teammate:

We offer a competitive benefits package that is on par with most of the leading healthcare organizations. Apply today if you are interested in getting your name in the mix!

Essential Duties and Responsibilities:

As a Claims Compliance Auditor you will…

• Support internal and external claims auditing efforts, including an assessment of:
• Claims accuracy
• Eligibility
• Accumulation
• Pricing
• Plan Design Adherence
• Coding/Diagnosis decision-making
• Assist with responses provided to third-party auditors including preparatory review of sample claims, discussion responses, and review of draft audit reports
• Independently perform claims accuracy reviews targeting high-risk areas or work plan items to determine compliance and financial accuracy
• Review internal coding/claims processing efforts to provide recommendations related to regulatory and plan requirements
• Draft audit reports resulting from claims compliance reviews

Supervisory Responsibilities: This position has no supervisory responsibilities.

Expectations of Performance: The employee in this role shall be considered to be performing in an acceptable manner when carrying out the Core Values:

• Independent
• Detail Oriented
• Integrity
• Positive Attitude

Education and/or Experience:

• Significant health care claims experience and health claims rev cycle
• Familiarity with EDI files
• Knowledge of CORE standards (837/835s)
• CCS Certified (Inpt/outpt) or CPC with Facility (837I) experience
• Coding Expertise (inpt/outpt, assignment of benefits)
• CPT/HCPCS/ICD-10/Revenue Codes
• Knowledge of NUCC/NUBC
• X-12 CARC/RARC Claims adjustment reason code knowledge
• NCPDP Claims (Retail Pharmacy & DME)

Nice to Have Skills:

• Exposure and understanding of NCPDP Claims
• Strong Healthcare Revenue Cycle Experience

Soft Skill/Attribute Requirements:

• Works independently
• Critical thinker

Computer Skills: To perform this job successfully, an individual should have knowledge of basic office equipment such as: "EMR (electronic medical record system), Microsoft Excel computer, internet, email, copy and fax machines, and telephone.

Work Environment: This position is going to be FULLY REMOTE.

Job Type: Full-time

$75.00 - 95.00 Hourly - FULL TIME

Benefits:

• 401k
• Dental insurance
• Health insurance
• Life insurance
• Sick Time/Paid Time Off
• Vision insurance

Schedule:

• Monday-Friday 8am-5pm (Flexible on Time Zones)

#MedixMW