[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