Claims Auditor
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Job Description
Claims Auditor auditing medical billing accuracy and compliance for MedPOINT Management, an IPA healthcare management company. Identifying payment discrepancies and improving claims operations remotely.
Responsibilities:
- Audit medical claims for accuracy, completeness, and compliance with payer guidelines and contractual agreements
- Review and analyze claims data to identify billing errors, overpayments, and underpayments
- Conduct pre- and post-payment audits to ensure proper reimbursement and reduce financial risk
- Document audit findings and prepare detailed reports for management review
- Collaborate with claims processing and provider relations teams to resolve discrepancies
- Monitor claims trends and recommend process improvements to enhance accuracy and efficiency
- Ensure compliance with federal, state, and managed care regulations, including ICD-10, CPT, and HCPCS coding standards
Requirements:
- 2+ years of experience in claims auditing, claims processing, or healthcare billing
- Strong knowledge of ICD-10, CPT, and HCPCS coding
- Familiarity with managed care, IPA, or HMO claims environments preferred
- Proficiency in claims management systems and Microsoft Office Suite
- Exceptional attention to detail and strong analytical skills
- Excellent written and verbal communication skills for reporting and cross-team collaboration
- CPC, CCA, or related coding/billing certification is a plus
Benefits:
- 401(k)
- 401(k) matching
- Company parties
- Dental insurance
- Employee discounts
- Health insurance
- Opportunity for advancement
- Paid time off
- Parental leave
- Savings bank
- Training & development
- Vision insurance
- Wellness resources
- Collaborative work culture
- Professional growth opportunities
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