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 3 years of experience handling appeal claims in a hospital or healthcare setting. • Ability to interpret EOBs and UB-04 claim forms required. • Working knowledge of ICD-10, CPT, HCPCS, DSM-IV, and CMS-1500 forms preferred. • Certification in medical coding (CPC, CCS, or equivalent) strongly preferred. • Strong analytical and problem-solving skills with high attention to detail. • Proficiency in Microsoft Office applications, particularly Excel and Word. • Excellent communication skills and ability to work effectively in a remote environment. Benefits: • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies Apply tot his job