Remote Medical Claims Auditor

A company is looking for a Remote Medical Claims Compliance Auditor. Key Responsibilities Conduct routine monitoring and audits of billing systems and claims processes Ensure compliance with client contract criteria and prepare for annual Health Plan audits Monitor processes to detect fraud, abuse, or waste and assist with compliance responsibilities Required Qualifications 3-5 years of experience in the healthcare or managed care industry, including claims/reimbursement 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 Bachelor's degree in healthcare informatics, business administration, or related field preferred

Apr 17, 2025 - 18:57

A company is looking for a Remote Medical Claims Compliance Auditor. Key Responsibilities Conduct routine monitoring and audits of billing systems and claims processes Ensure compliance with client contract criteria and prepare for annual Health Plan audits Monitor processes to detect fraud, abuse, or waste and assist with compliance responsibilities Required Qualifications 3-5 years of experience in the healthcare or managed care industry, including claims/reimbursement 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 Bachelor's degree in healthcare informatics, business administration, or related field preferred