[Hiring] Stop Loss Claims Auditor @Imagine360

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Medical Auditor is responsible for auditing medical facilities and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. • Review medical facility and professional claims for accuracy and apply standard coding rules, guidelines and conventions • Enter billing information into the appropriate report format for the client requesting the work • Review contracts and apply contractual adjustments to the medical charges • Audit charges for CPT coding and compliance with state and federal regulations • Process and access coding patterns and identify signs of fraud and abuse • Review medical records to verify accurate coding • Ensure accuracy of work product • Proficient in meeting quality and quantity standards • Able to learn and properly utilize proprietary software programs essential to support the job function • Adhere to HIPAA guidelines and regulations • Perform additional duties assigned by management Qualifications • High School Diploma or equivalent • Minimum 2 years Claims Coding or Medical Billing experience • Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms • Medicare Reimbursement / Denial experience preferred • AAPC Certification and ICD-10 Proficient is required • Prior experience in the Self-Funded Industry is desired Benefits • Multiple Health Plan Options • Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance • Parental Leave Policy • 20 days PTO to start / 10 Paid Holidays • Tuition reimbursement • 401k Company contribution • Professional development initiatives / continuous learning opportunities • Opportunities to participate in and support the company's diversity and inclusion initiatives Apply tot his job Apply To this Job