Claims Audit & Quality Assurance Specialist

Highmark Health; Raleigh (NC); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Health is seeking a claims auditor with extensive knowledge of CPT/HCPCS/ICD coding and at least five years of medical claims processing experience. The role emphasizes accuracy, coaching, and adherence to internal procedures.

Responsibilities include auditing workflows, training staff, and providing expertise on complex claim situations, while communicating effectively with management and clients.

Qualifications

• 5 years of medical claims processing experience.
• Knowledge of CPT/HCPCS/ICD9/ICD10.
• Strong attention to details and organizational skills.
• Excellent verbal and written communication.
• Proficient in MS Excel and MS Word.
• Ability to work independently and in a team.

Responsibilities

• Review claims audits and ensure adherence to procedures.
• Provide coaching, training, and guidance to staff.
• Record audit results for monthly reporting and metrics.
• Assist with system upgrade testing as needed.
• Liaise with clients and management to resolve complex claims.

Skills

Medical coding

Attention to detail

Problem solving

Communication

MS Excel

MS Word

Judgement

Teamwork

Education

High School Diploma

Associate degree

Job description

Highmark Health is seeking a claims auditor with extensive knowledge of CPT/HCPCS/ICD coding and at least five years of medical claims processing experience. The role emphasizes accuracy, coaching, and adherence to internal procedures.

Responsibilities include auditing workflows, training staff, and providing expertise on complex claim situations, while communicating effectively with management and clients.