Stop Loss Claims Auditor
Imagine360 is currently seeking a Medical Billing Auditor to join our team! The Medical Auditor is responsible for auditing medical facilities and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. Candidate must possess a strong understanding of Medicare and Medicare guidelines. Must display a high degree of independent judgement and professional skepticism that enhances the work performed in order to achieve success in this position.
Position Location : 100% remote
Responsibilities include but are not limited to :
• 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.
Required Experience / Education :
• 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
• Medicare Reimbursement / Denial experience preferred
• AAPC Certification and ICD-10 Proficient is required
• Prior experience in the Self-Funded Industry is desired
What can Imagine360 offer you?
• 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
Want to see our latest job opportunities? Follow us on LinkedIn
Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.
Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
• *RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**
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Position Location : 100% remote
Responsibilities include but are not limited to :
• 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.
Required Experience / Education :
• 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
• Medicare Reimbursement / Denial experience preferred
• AAPC Certification and ICD-10 Proficient is required
• Prior experience in the Self-Funded Industry is desired
What can Imagine360 offer you?
• 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
Want to see our latest job opportunities? Follow us on LinkedIn
Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.
Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
• *RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**
Apply tot his job
Apply To this Job