Medical Claims Auditor
Job Description: • Review medical claims, supporting documentation, and medical records to ensure completeness, accuracy, and compliance with company policies and industry standards • Validate coding accuracy using ICD-10, CPT, and HCPCS guidelines • Interpret and analyze Explanation of Benefits (EOB) and UB-04 claim forms to verify correct billing and payment data • Identify and document discrepancies such as duplicate claims, unbundled services, upcoding, and other billing errors • Communicate audit findings and recommend corrective actions to the claims processing team or management • Apply auditing methodologies and regulatory guidelines (CMS, Medicaid, Medicare, and payer contracts) to ensure claims integrity • Support process improvements to enhance claim accuracy and reduce billing errors Requirements: • Minimum of three (3) years of direct medical claims collections experience • Strong knowledge of insurance policy types (HMO, PPO, EPO, Medicare, Medicaid) • Advanced understanding of Explanation of Benefits (EOBs) and medical billing forms UB-04 and HCFA-1500 • Experience navigating payer portals and health information systems (e.g., Availity, Navinet) • Demonstrated ability to perform high-volume outreach and communication Benefits: • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies Apply tot his job
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