Claims Audit & Compliance Specialist

Highmark Health; Sacramento (CA); On-site; USD 2,893,000 - 4,539,000; Full time

Job summary

Highmark Inc. is seeking an experienced claims auditor to ensure audits are completed on time and in compliance with plan documents and regulatory requirements. You will review CPT, HCPCS, ICD9/ICD10 coding, coach staff, and support system upgrades.

The role requires 5 years of claims processing experience in medical/dental/vision, strong communication, problem solving, and the ability to work independently or in a team within a fast-paced environment.

Qualifications

• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 medical coding.
• Strong attention to details and organizational skills.
• Excellent problem solving and ability to work in a fast paced production environment.
• Excellent written and verbal communication skills.
• Basic PC navigation for professional work environment.
• Basic MS Excel and MS Word proficiency.
• Ability to make sound decisions referencing all available resources.

Responsibilities

• Ensure all claims are handled according to internal procedures and review plan wording.
• Monitor audits to meet turnaround time and maintain audit quality.
• Record results for monthly reporting and assist with training sessions.
• Coach staff and provide guidance on questions related to claims processing.

Skills

CPT coding

HCPCS coding

ICD9/ICD10 coding

Attention to detail

Problem solving

Communication skills

PC navigation

MS Excel

MS Word

Independent / Teamwork

Education

HS/GED

Associate Degree

Tools

MS Excel

MS Word

Job description

Highmark Inc. is seeking an experienced claims auditor to ensure audits are completed on time and in compliance with plan documents and regulatory requirements. You will review CPT, HCPCS, ICD9/ICD10 coding, coach staff, and support system upgrades.

The role requires 5 years of claims processing experience in medical/dental/vision, strong communication, problem solving, and the ability to work independently or in a team within a fast-paced environment.