Compliance Medical Claims Auditor
Compliance Medical Claims Auditor
Responsibilities:
• Support internal and external claims auditing efforts, including an assessment of:
• Claims accuracy
• Eligibility
• Accumulation
• Pricing
• Plan Design Adherence
• Coding/Diagnosis decision-making
• Assist with responses provided to third-party auditors including preparatory review of sample claims, discussion responses, and review of draft audit reports
• Independently perform claims accuracy reviews targeting high-risk areas or work plan items to determine compliance and financial accuracy
• Review internal coding/claims processing efforts to provide recommendations related to regulatory and plan requirements
• Draft audit reports resulting from claims compliance reviews
Qualifications:
• Significant health care claims experience and health claims rev cycle
• Familiarity with EDI files
• Knowledge of CORE standards (837/835s)
• CCS Certified (Inpt/outpt) or CPC with Facility (837I) experience
• Coding Expertise (inpt/outpt, assignment of benefits)
• CPT/HCPCS/ICD-10/Revenue Codes
• Knowledge of NUCC/NUBC
• X-12 CARC/RARC Claims adjustment reason code knowledge
• NCPDP Claims (Retail Pharmacy & DME)
Compensation: $50 - $70 per hour
ID#: 2335
Cypress HCM, LLC
www.cypresshcm.com
(415) 394 – 6400
Apply Now
Apply Now
Responsibilities:
• Support internal and external claims auditing efforts, including an assessment of:
• Claims accuracy
• Eligibility
• Accumulation
• Pricing
• Plan Design Adherence
• Coding/Diagnosis decision-making
• Assist with responses provided to third-party auditors including preparatory review of sample claims, discussion responses, and review of draft audit reports
• Independently perform claims accuracy reviews targeting high-risk areas or work plan items to determine compliance and financial accuracy
• Review internal coding/claims processing efforts to provide recommendations related to regulatory and plan requirements
• Draft audit reports resulting from claims compliance reviews
Qualifications:
• Significant health care claims experience and health claims rev cycle
• Familiarity with EDI files
• Knowledge of CORE standards (837/835s)
• CCS Certified (Inpt/outpt) or CPC with Facility (837I) experience
• Coding Expertise (inpt/outpt, assignment of benefits)
• CPT/HCPCS/ICD-10/Revenue Codes
• Knowledge of NUCC/NUBC
• X-12 CARC/RARC Claims adjustment reason code knowledge
• NCPDP Claims (Retail Pharmacy & DME)
Compensation: $50 - $70 per hour
ID#: 2335
Cypress HCM, LLC
www.cypresshcm.com
(415) 394 – 6400
Apply Now
Apply Now