Job description

The claims auditor will be responsible for coordinating and completing audits as well as compiling and reporting results and trends accurately, appropriately, and timely. Applicants MUST have 5 years of comprehensive experience with the processing or auditing of medical claims. The applicant must have a history of excellent quality results.

Essential Duties and Responsibilities:

• Logging/Tracking all Claims/Tasks to be audited
• Assist with all audit programs currently in place as well as identifying issues for future audit programs
• Assist with other tasks as needed and identified by Claims Management
• Weekly meetings with Management to report on audit trends and training suggestions
• Performs post payment medical record review audits of claims payments to identify potential waste, abuse and/or overpayment.
• Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified.
• Responsible for assisting the team with potential waste or abuse investigations requiring medical coding expertise, participating in external audit requests, and special projects as needed.
• Coordinates, conducts, and documents audits as needed.
• Prepares written reports or trending data related to findings and facilitates timely turnaround of audit results.
• Prepares written summaries of audit results for purposes of reporting potential waste, abuse and/or overpayment.
• Retrieves and compiles data across multiple information systems and provides needed information for internal and external customers in a timely manner.
• Reviews provider billing practices to investigate claims data and compliance with State and Federal laws.
• Determines and calculates overpayment/underpayment, appropriately documents and participates in steps to remediate.

Qualifications:

• Medical Coder certification from accredited sources (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required
• CPC or CRC required
• Prior experience in Medicare claims role and/or post payment medical coding auditor role preferred
• Knowledge of Medicare rules, claims processing, medical terminology and coding principles and practices
• Knowledge of auditing, investigation, and research.
• Knowledge of word processing software, spreadsheet software, and internet software
• Manage time efficiently and follow through on duties to completion
• Must have knowledge of the entire revenue cycle

Affirmative Action Statement

Applicants must be currently authorized to work in the United States.

We are proud to be an Equal Opportunity and Affirmative Action employer, and consider qualified applicants without regard to race, color, creed, religion, ancestry, national origin, sex, sexual orientation, gender identity, age, disability, veteran status or any other protected factor under federal, state or local law.

Job Type: Full-time

Pay: $50,000.00 - $60,000.00 per year

Benefits:

• Health insurance
• Paid time off

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Mount Dora, FL 32757: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• How many years of comprehensive experience with the processing or auditing of medical claims you have?

Experience:

• ICD-10: 1 year (Preferred)

Work Location: One location

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