Claims Auditor
Title : Claims Compliance Auditor
Start : ASAP
W2 Contract Duration : 6 months
Location : Remote
Hours per Week : Flexible for Part-Time or Full-Time; 20-40 hours / week
Pay Range : $75-95 / hr
Skills required :
- Significant healthcare claims experience and health claims revenue cycle
- Familiarity with EDI files
- Knowledge of CORE standards (837 / 835s)
- CCS Certified (Inpatient / Outpatient) or CPC with Facility (837I) experience
- Coding Expertise (Inpatient / Outpatient, Assignment of Benefits)
- Proficiency with CPT / HCPCS / ICD-10 / Revenue Codes
- Knowledge of NUCC / NUBC standards
- X-12 CARC / RARC Claims Adjustment Reason Code knowledge
Tasks :
- NCPDP Claims (Retail Pharmacy & DME)
- Support internal and external claims auditing efforts, including assessment of :
- Claims accuracy
- Eligibility
- Accumulation
- Pricing
- Plan design adherence
- Coding / Diagnosis decision-making
- Assist with responses 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
Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.
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