Managed Care Claims Compliance Coordinator

A company is looking for a Remote Managed Care Claims Compliance Coordinator. Key Responsibilities Conduct routine monitoring and audits of billing systems and client services for compliance Generate and submit required Commercial claims reporting and assist in annual Health Plan audits Monitor processes to detect fraud, abuse, or waste, and participate in appeals and auditing responsibilities Required Qualifications 3-5 years of experience in the healthcare or managed care industry, including claims/reimbursement experience 3 years of auditing experience in the healthcare industry Knowledge of CPT and ICD coding, Medicare requirements, and APC Pricing Advanced proficiency in Microsoft Office products, especially Excel and Access Bachelor's degree in healthcare informatics, business administration, or related field is preferred

Apr 17, 2025 - 18:57

A company is looking for a Remote Managed Care Claims Compliance Coordinator. Key Responsibilities Conduct routine monitoring and audits of billing systems and client services for compliance Generate and submit required Commercial claims reporting and assist in annual Health Plan audits Monitor processes to detect fraud, abuse, or waste, and participate in appeals and auditing responsibilities Required Qualifications 3-5 years of experience in the healthcare or managed care industry, including claims/reimbursement experience 3 years of auditing experience in the healthcare industry Knowledge of CPT and ICD coding, Medicare requirements, and APC Pricing Advanced proficiency in Microsoft Office products, especially Excel and Access Bachelor's degree in healthcare informatics, business administration, or related field is preferred