Claims Auditor

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

📋 Description

• Perform audits on medical claims to ensure they meet accuracy, completeness, and adherence to payer guidelines as well as contractual agreements.

• Analyze claims data to detect billing inaccuracies, overpayments, and underpayments.

• Execute both pre- and post-payment audits to guarantee appropriate reimbursement and mitigate financial risks.

• Record audit results and create comprehensive reports for management evaluation.

• Work in partnership with claims processing and provider relations teams to address any discrepancies.

• Track claims trends and suggest process enhancements to improve accuracy and efficiency.

• Maintain compliance with federal, state, and managed care regulations, including ICD-10, CPT, and HCPCS coding standards.

⛳️ Requirements

• A minimum of 2 years of experience in claims auditing, claims processing, or healthcare billing.

• In-depth knowledge of ICD-10, CPT, and HCPCS coding.

• Preference for familiarity with managed care, IPA, or HMO claims environments.

• Competence in claims management systems and proficiency in the Microsoft Office Suite.

• Outstanding attention to detail coupled with strong analytical abilities.

• Excellent written and verbal communication skills essential for reporting and collaboration across teams.

• CPC, CCA, or any related coding/billing certification would be advantageous.

🏝️ Benefits

• 401(k)

• 401(k) matching

• Company parties

• Dental insurance

• Employee discounts

• Health insurance

• Opportunity for advancement

• Paid time off

• Parental leave

• Savings bank

• Training & development

• Vision insurance

• Wellness resources

• Collaborative work culture

• Professional growth opportunities