Job description

Job Title: Medical Claims Auditor

Job Location: Irving, Texas/ Fully Remote

Job Description:

Must have Pharmacy Claims Experience, please do not submit candidates who do not have this experience as it's required.

Skills would be:

• problem solving, written and verbal communication, teamwork and collaboration, active listening, adaptability, decision-making, customer service, organization, Microsoft Office (especially WORD, EXCEL and OUTLOOK), self-motivation, attention to detail, time management, SQL (preferred, but not required) and phone etiquette.
• This person should be local and have the ability to work from home. I’d like this person to come back to the office with us if/when this happens. Must have strong internet at home.
• We are seeking a talented individual for a Medical Claims Auditor I who performs research analytics to support our recovery audit line of business. Assists in the development and implementation of new data mining and audit/review methodologies for identifying healthcare overpayments and underpayments to providers, and the detection of healthcare fraud, waste, and abuse.

Essential Responsibilities:

• Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements. Applies knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new overpayment recovery opportunities. Works with data miners, clinical staff, and stakeholders to identify new overpayment issues for each client.
• Tracks, and follows-up on results and recoveries
• Contributes new ideas for improving existing audit processes and audit queries. Works cohesively with the audit team.
• Develops, maintains, and ensures adherence to multiple project schedules

Knowledge, Skills and Abilities:

• Strong Conceptual and analytical skills
• Strong Project management skills
• Ability to develop, organize, and maintain project plans and agendas
• Ability to effectively interface with clients on the phone and in person
• Working knowledge of Microsoft Suite of products (Excel, Word, Access)
• Sound understanding or medical terminology and anatomy.
• Good understanding of Medicaid required Medicare and commercial experience a plus.
• In depth knowledge of coding principals including but not limited to NCCI Edits, CPT, HCPCS and ICD-9 codes and modifiers; and/or MSDRG, Revenue codes, and APCs.
• In-depth knowledge of UB04 and medical (1500) claim formats and requirements.

Minimum Education:

High school diploma or GED required; Bachelor’s degree preferred

Minimum Related Work Experience:

• 1-3 years of healthcare reimbursement experience such as provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing, and/or revenue cycle improvement required.
• Must have demonstrated experience and knowledge of healthcare claims processing (Medicaid, Medicare, Commercial Insurance), including ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, etc. preferred.
• Experience in healthcare auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred.
• Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience a plus preferred

Job Types: Full-time, Contract

Salary: $20.00 - $22.00 per hour

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Irving, TX 75038: Reliably commute or planning to relocate before starting work (Required)

Experience:

• ICD-10: 2 years (Preferred)

Work Location: One location

Speak with the employer
+91 6306358734

blackflymedia.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, blackflymedia.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, blackflymedia.com is the ideal place to find your next job.