Claims Quality Auditor

A company is looking for a Claims Quality Auditor to perform comprehensive audits of claims and identify incorrect payments.

Key Responsibilities

Conduct quality audits of claims using various sources of information

Analyze errors to determine root causes and classify them appropriately

Utilize audit software to document audit observations and facilitate corrective action plans

Required Qualifications

Associate's degree in a related field or equivalent experience

2+ years of experience in medical or pharmacy claims processing, training, or auditing

Knowledge of claim software systems and Microsoft Office applications

Familiarity with Medicaid and Medicare reimbursement rules

Preferred knowledge of CPT / HCPCS Coding