Claims Audit Lead - Compliance & Training

Highmark Health; Phoenix (AZ); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking a claims auditor to ensure audits and claim processing align with internal procedures and plan documents. The role involves coaching staff, managing refunds, and assisting with specialized audits.

Candidate should have strong CPT/HCPCS/ICD coding knowledge and be proficient in MS Excel/Word, with the ability to work independently or in a team. This position is based in Phoenix with on-site requirements.

Qualifications

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

Responsibilities

• Ensure all claims are processed according to internal procedures and plan documents.
• Monitor and audit workflows to meet turnaround time guidelines.
• Maintain workloads aligned with quality and production standards.
• Record audit results and assist with training sessions for issues identified.
• Provide coaching to the claims team, including trainees.
• Offer recommendations for refunds, Voids and stop payments as needed.
• Assist with specialized audits for SOC, carrier, vendor and employer audits.
• Maintain knowledge of benefits, regulations, and system upgrades.

Skills

CPT/HCPCS/ICD coding

Attention to detail

Problem solving

Communication skills

MS Excel basics

MS Word basics

Sound decision making

Independent and team work

Education

HS/GED

Associate Degree preferred

Tools

MS Word

MS Excel

Job description

Highmark Inc. is seeking a claims auditor to ensure audits and claim processing align with internal procedures and plan documents. The role involves coaching staff, managing refunds, and assisting with specialized audits.

Candidate should have strong CPT/HCPCS/ICD coding knowledge and be proficient in MS Excel/Word, with the ability to work independently or in a team. This position is based in Phoenix with on-site requirements.