Employment Type: Contract (6 Months with Possible Extension)
Pay Rate: $56.50–$81.13/hr

Interview Week: Week of August 4, 2025
Target Start Date: August 19, 2025

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Position Overview:

We are actively seeking a highly skilled Compliance Medical Claims Auditor for a fully remote, 6-month contract opportunity (with potential to extend). This position supports both internal and external audit functions, assessing claim accuracy, eligibility, pricing, coding, and adherence to plan design.

This role is ideal for professionals with deep Revenue Cycle Management (RCM) experience, a robust understanding of claims processing workflows, and the ability to independently conduct detailed audit reviews.

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Key Responsibilities:

• Conduct claim accuracy audits, assessing:

  • Eligibility

  • Pricing

  • Accumulator alignment

  • Plan design adherence

  • Diagnosis and coding decisions

• Assist with responses to third-party auditors, including:

  • Reviewing sample claims

  • Drafting discussion responses

  • Reviewing audit report drafts

• Identify trends and provide recommendations related to compliance and regulatory guidelines

• Draft formal audit reports outlining findings and improvement suggestions

• Monitor for improper adjudication, fraud, or abuse signals

• Review EDI transactions and assess claims against standards (837/835, X12, etc.)

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Must-Have Qualifications:

• 5–10 years of experience in coding and/or claims adjudication (preferably payer side)

• Minimum 3 years specifically in audit roles

• Active CPC or CCS certification

• Deep knowledge of:

  • CPT, HCPCS, ICD-10, Revenue Codes

  • NUCC, NUBC, CORE Standards

  • X12 codes (CARC/RARC), NCPDP (Retail Pharmacy & DME)

  • EDI file handling (837/835)

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Preferred Skills & Traits:

• Strong written and verbal communication

• Self-motivated and organized

• High attention to detail

• Able to work independently in a remote environment

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Assessment Requirement (MANDATORY to Apply):

Before submission, all applicants must complete the following:

1. Claims Auditor Assessment
   ➡️ Take the Assessment

2. Assessment Questions
   ➡️ Download and complete questions as a Microsoft Word file.

📝 Note: Your resume will not be considered unless both the assessment and question responses are submitted.

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Schedule & Hours:

• Monday to Friday (flexible schedule)

• Core hours: 10:00 AM – 4:00 PM EST

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IT Equipment: Provided

Remote: 100%

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About the Interview Process:

• Hiring Manager: Diana

• Format: Virtual

• Timeline: Week of 8/4/2025

• Expect follow-up within 24–48 hours after submission or interview.

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Why This Role is Open:

Increased claims volume requiring audit support.

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Want to Apply?

Submit your resume, completed assessment, and questionnaire responses to be considered. This is an excellent opportunity to join a high-functioning team in a well-respected organization with the flexibility of remote work and the potential for contract extension.

 

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.