Job Details

A company is looking for a Claims Auditor.Key ResponsibilitiesConduct pre-check run auditing on various reports prior to finalizing the check run, managing timelines effectivelyAssist with Health Plan claim audits and provide feedback to management and staff regarding resultsComplete Claims Appeals and 095 processes according to health plan and company guidelines within established timeframesRequired QualificationsBachelor's degree or equivalent experience required4-5 years of experience in claim processingSpecific knowledge of claims and processes in a Commercial BC/BS HMO organizationExtensive knowledge of CPT 4, HCPCS, UB-04, and ICD-10 codingMedical terminology knowledge