Certified Medical Claims Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Examine medical invoices to pinpoint suitable billing, coding, and potential savings opportunities.

• Investigate and resolve claim discrepancies that demand a higher level of expertise beyond the initial assessment.

• Partner with the Negotiation team to address more intricate claim issues and secure further savings.

• Present findings to clients via comprehensive Bill Review Reports and assist in addressing complex bill-related questions.

• Assess and respond to requests for bill reconsideration, including those necessitating additional research or analysis.

• Manage escalated provider inquiries, settle disputes, and engage in direct negotiations concerning billing discrepancies.

• Offer guidance and mentor junior analysts in best practices for claim review.

• Aid in identifying patterns in billing problems, suggesting system/process enhancements, and contributing to policy formulation.

• Assist in training initiatives by informing internal teams and clients about updates to codes, edits, and bill review procedures.

• Collaborate with internal teams to discover and implement process efficiencies that enhance savings and client satisfaction.

• Ensure adherence to HIPAA and other regulatory requirements.

• Execute additional duties as assigned.

⛳️ Requirements

• Minimum of 3 years of experience in auditing, claims review, and/or billing within a healthcare organization.

• CPC and/or CIC certification required.

• Familiarity with industry coding, including ICD-10, CPT, HCPCS Revenue codes, etc.

• Outstanding verbal and written communication skills.

• Understanding of CMS guidelines.

• Preferred qualifications include: Experience in DRG validation.

• Knowledge of Health Insurance, Medicare regulations, and various healthcare programs.

• Experience with RevCycle Pro, Encoder Pro, and/or SuperCoder software.

🏝️ Benefits

• Competitive benefits package with generous employer subsidies.

• Flexible and remote work options available.

• 401k plan with a generous employer match and immediate vesting.

• Opportunities for personal and professional development.

• Supportive family benefits, including paid leave for new family members.

• Companywide philanthropic initiative, Valenz Communities Connection.