[Hiring] Stop Loss Claims Auditor @Imagine360

Role Description

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.

• 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 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 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

Qualifications

• 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

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