Certified Claims Auditor - WI/MN

Marshfield Clinic Health System; United States; Remote; USD 50,000 - 70,000; Full time

Job summary

A health services organization is seeking a Claims Auditor for a remote position in the United States. This role involves performing audits on health insurance claims for accuracy and compliance. Candidates must have at least three years of experience in claim processing and relevant coding, along with a high school diploma. Certification as a Professional Coder is required within three years of hire.

Qualifications

• Three years of experience in health insurance claim processing.
• Three years of experience with CPT/HCPCS and ICD coding.
• Certified Professional Coder (CPC) or CPC-P certification required within three years of hire.

Responsibilities

• Perform audits on payment and procedural accuracy.
• Analyze and report findings from audits.
• Maintain knowledge of relevant coding systems.

Skills

Audit procedures

Claim processing knowledge

CPT/HCPCS coding

ICD coding

Education

High school diploma or equivalent

Associate degree in business or related field

Job description

A company is looking for a Claims Auditor (Remote - WI or MN).

Key Responsibilities

• Perform payment, procedural accuracy, turnaround time, compliance, and operational audits
• Apply effective audit procedures in collecting, analyzing, and reporting findings
• Maintain working knowledge of claim processing and relevant coding systems

Required Qualifications, Training, and Education

• High school diploma or equivalent required
• Three years of experience in health insurance claim processing
• Three years of experience with CPT/HCPCS and ICD coding
• Certified Professional Coder (CPC) or Certified Professional Coder - Payer (CPC-P) certification required within three years of hire
• Preferred: Associate degree in business, medical, or related field