Provider Reimbursement Auditor

This is a fully remote position, open to applicants in California, +3 more states.

📋 Description

• Conduct thorough audits of provider claims against source documents to detect mis-payments.

• Execute quality audits of provider claims, both pre- and post-payment, utilizing eligibility, enrollment, state contracts, provider and facility agreements, as well as state and health plan billing manuals.

• Examine errors and identify root causes to assign appropriate error responders.

• Utilize audit software to generate written documentation regarding audit findings.

• Analyze and review feedback on audit findings to ensure accuracy.

• Update audit criteria as necessary, which includes maintaining state ACME and checking state websites for updates.

• Record business decisions and determine necessary updates for department pricing tools.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Associate’s degree in a relevant field or equivalent experience.

• A minimum of 2 years’ experience in medical or pharmacy claims processing or claims pricing.

• Proficient in Excel.

• Experience with provider claims is essential.

• Capability to interpret Medicaid and Medicare reimbursement regulations.

• Ability to understand state and provider contracts.

• Familiarity with CPT/HCPCS coding is preferred.

• Experience in remote work is highly desirable.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plans.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.