Medical Claims Auditor at Imagine360 in USA

Job description

• Imagine360 is seeking a Medical Claims Auditor to join the team! The Medical Claims Auditor is responsible for assisting with our business process review to ensure accurate payment and operational efficiencies. The Medical Claims Auditor will review professional and facility claims for accuracy and compliance with industry standard guidelines and contractual language on behalf of our clients. The Medical Claims Auditor must demonstrate a coder's aptitude, proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer's perspective.
• Position Location: 100% remote

Responsibilities

• Review professional and facility claims for accuracy and apply standard coding rules, guidelines, and conventions.
• Review supporting documentation, analyze medical records and itemized bills to validate appropriateness of billing and coding procedures.
• Review contracts and apply contractual adjustments to the medical charges.
• Audit codes and services performed by providers according to ICD-10, CPT, HCPCS and CMS Guidelines.
• Apply appropriate reimbursement methodology.
• 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.
• Learn to properly utilize proprietary software programs essential to support the job function.
• Adhere to HIPAA guidelines and regulations.
• Provide support and back up within the department and cross-functionally.
• Ability to work well in an individual and team environment.
• Meet and or exceed daily production and quality goals and performance objectives.
• Other duties as needed.

Requirements

• High School Diploma or equivalent required
• Minimum 2 years Claims Coding or Medical Billing experience required
• Medicare Reimbursement / Denial experience
• Prior experience in the Self-Funded Industry
• Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms.
• Medicare reimbursement/denial experience preferred.
• Communication (written, verbal, and listening), interpersonal and analytic skills.
• Ability to use software related to job responsibilities including MS Office with proficiency in Excel and Outlook.
• Strong attention to detail.
• Ability to maintain a grasp of business and departmental process rules.
• Ability to produce quality work while meeting production goals.
• Coding / Nursing Certification and ICD-10 proficiency is required.
• Familiarity with CMS/Medicare
• Familiarity with rev codes, HCPCS, DRG
• Coding Certification (CPC, CCA, CCS, RHIA, etc.) and / or Nursing Licensure (RN, LPN, etc.)

Skills

Required

• Strong attention to detail.
• Familiarity with CMS/Medicare
• Familiarity with rev codes, HCPCS, DRG

Benefits

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives