Claims Audit Specialist: Detail-Driven Auditor

Highmark Health; Montpelier (VT); Presencial; USD 2 976 000 - 4 539 000; Tempo integral

Resumo da oferta

Highmark Inc. is seeking a claims audit professional responsible for reviewing and ensuring claims processing aligns with internal procedures and plan documents. You will monitor audits, provide coaching, and assist with specialized audits as needed.

The role requires 5 years of claims processing experience, strong CPT/HCPCS/ICD knowledge, and solid communication skills. The position emphasizes accuracy, teamwork, and independent judgment in a fast-paced environment.

Qualificações

• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 coding.
• Strong attention to details with organizational skills.
• Excellent problem solving in fast-paced production environments.
• Excellent verbal and written communication skills.
• Proficient PC navigation in a professional setting.
• Basic MS Excel skills.
• Basic MS Word skills.
• Ability to use judgement to make sound decisions with available resources.

Responsabilidades

• Ensure all claims handling follows internal procedures and plan wording.
• Monitor audit workflow for timely turnaround times.
• Maintain workload to meet quality and production standards.
• Record results in audit tools and provide training insights.
• Conduct one-on-one coaching with the claims team, including trainees.
• Provide recommendations for dollar authorization based on audit stats.

Conhecimentos

CPT/HCPCS/ICD knowledge

Attention to detail

Problem solving

Communication skills

Teamwork

Judgement/decision making

Fast-paced environment

Formação académica

HS/GED

Associate degree preferred

Ferramentas

MS Excel

MS Word

Descrição da oferta de emprego

Highmark Inc. is seeking a claims audit professional responsible for reviewing and ensuring claims processing aligns with internal procedures and plan documents. You will monitor audits, provide coaching, and assist with specialized audits as needed.

The role requires 5 years of claims processing experience, strong CPT/HCPCS/ICD knowledge, and solid communication skills. The position emphasizes accuracy, teamwork, and independent judgment in a fast-paced environment.