Texas Licensed Medical Claims Auditor

A company is looking for a Medical Claims Auditor (Remote - Texas).

Key Responsibilities

Review medical claims and supporting documentation for accuracy and compliance

Validate coding accuracy using ICD-10, CPT, and HCPCS guidelines

Identify discrepancies in claims and communicate findings to the claims processing team

Required Qualifications

Minimum of 3 years of experience in handling appeal claims in a healthcare setting

Ability to interpret Explanation of Benefits (EOB) and UB-04 claim forms

Working knowledge of ICD-10, CPT, HCPCS, DSM-IV, and CMS-1500 forms preferred

Certification in medical coding (CPC, CCS, or equivalent) strongly preferred

Proficiency in Microsoft Office applications, particularly Excel and Word