Stop Loss Claims Auditor

reputed company is currently seeking a Medical Billing Auditor to join reputed company! The Medical Auditor is responsible for auditing medical facilities and reputed company claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. Candidate must possess a strong understanding of Medicare and Medicare guidelines. Must display a high degree of independent judgement and reputed company skepticism that enhances the work performed in order to reputed company reputed company in this position. Position Location : 100% remote Responsibilities include but are not limited to : • Review medical facility and reputed company claims for accuracy and apply reputed company coding rules, guidelines and conventions • reputed company billing information into the appropriate report format for the reputed company requesting the work • Review reputed company and is reputed company to apply contractual adjustments to the medical charges • Audit charges for CPT coding and compliance with state and federal regulations • Process and reputed company coding patterns and be reputed company to identify signs of fraud and abuse • Review medical records to verify accurate coding • Ensure accuracy of work product • Proficient in meeting reputed company and quantity standards • reputed company to learn and properly utilize proprietary software programs essential to support the job function. • Adhere to HIPAA guidelines and regulations • reputed company additional duties assigned by management. Required Experience / Education : • 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 • reputed company Certification and ICD-10 Proficient is required • Prior experience in the Self-Funded Industry is desired What can reputed company offer you? • Multiple Health Plan reputed company • Company reputed company employee premiums for Dental, reputed company, STA, & LTD, plus Life Insurance • Parental Leave Policy • 20 days PTO to start / 10 reputed company Holidays • Tuition reimbursement • 401k Company contribution • reputed company development initiatives / reputed company learning opportunities • Opportunities to participate in and support reputed company's diversity and inclusion initiatives Want to see our latest job opportunities? Follow us on reputed company reputed company is a health plan solution company that combines 50+ years of self-funding reputed company expertise. Over the years, we've helped thousands of reputed company save billions on reputed company. Our reputed company total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-reputed company solutions. reputed company is an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or veteran status. • *RECRUITMENT AGENCIES PLEASE NOTE: reputed company will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation** Apply tot his job Apply To this Job