Compliance Medical Claims Auditor
Compliance Medical Claims Auditor
- Responsibilities:
- Support internal and external claims auditing efforts, including an assessment of:
- Claims accuracy
- Eligibility
- Accumulation
- Pricing
- Plan Design Adherence
- Coding/Diagnosis decision-making
- Assist with responses provided to third-party auditors including preparatory review of sample claims, discussion responses, and review of draft audit reports
- Independently perform claims accuracy reviews targeting high-risk areas or work plan items to determine compliance and financial accuracy
- Review internal coding/claims processing efforts to provide recommendations related to regulatory and plan requirements
- Draft audit reports resulting from claims compliance reviews
- Qualifications:
- Significant health care claims experience and health claims rev cycle
- Familiarity with EDI files
- Knowledge of CORE standards (837/835s)
- CCS Certified (Inpt/outpt) or CPC with Facility (837I) experience
- Coding Expertise (inpt/outpt, assignment of benefits)
- CPT/HCPCS/ICD-10/Revenue Codes
- Knowledge of NUCC/NUBC
- X-12 CARC/RARC Claims adjustment reason code knowledge
- NCPDP Claims (Retail Pharmacy & DME)
Compensation: $50 - $70 per hour
ID#: 2335
Cypress HCM, LLC
www.cypresshcm.com
(415) 394 – 6400
Apply Job!
Apply to this Job