[Remote] Stop Loss Claims Auditor

Note: The job is a remote job and is open to candidates in USA. Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. They are seeking a Medical Billing Auditor responsible for auditing medical claims for accuracy and compliance with industry laws and guidelines.

Responsibilities
• Review medical facility and professional claims for accuracy and apply standard coding rules, guidelines and conventions
• Enter billing information into the appropriate report format for the client requesting the work
• Review contracts and is able to apply contractual adjustments to the medical charges
• Audit charges for CPT coding and compliance with state and federal regulations
• Process and Access coding patterns and be able to identify signs of fraud and abuse
• Review medical records to verify accurate coding
• Ensure accuracy of work product
• Proficient in meeting quality and quantity standards
• Able to learn and properly utilize proprietary software programs essential to support the job function
• Adhere to HIPAA guidelines and regulations
• Perform additional duties assigned by management

Skills
• High School Diploma or equivalent
• Minimum 2 years Claims Coding or Medical Billing experience
• Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms
• AAPC Certification and ICD-10 Proficient is required
• Strong understanding of Medicare and Medicare guidelines
• Display a high degree of independent judgement and professional skepticism
• Proficient in meeting quality and quantity standards
• Able to learn and properly utilize proprietary software programs essential to support the job function
• Adhere to HIPAA guidelines and regulations
• Medicare Reimbursement / Denial experience preferred
• Prior experience in the Self-Funded Industry is desired

Benefits
• Multiple Health Plan Options
• Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

Company Overview
• Imagine360 is an integrated health plan addressing one of the greatest challenges on behalf of self-funded employers: healthcare costs are harming the bottom line, they're increasingly unaffordable for employees, and the experience remains poor. It was founded in 2003, and is headquartered in Philadelphia, Pennsylvania, USA, with a workforce of 1001-5000 employees. Its website is https://mibenefits.imagine360.com.

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