Claims Audit & Training Specialist

Highmark Health; Cheyenne (WY); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Health in Cheyenne, WY is seeking a claims audit specialist to ensure accurate processing of medical, dental, vision, FSA and HRA claims, and to monitor audits for timely outcomes.

You will review plan wording, apply CPT/HCPCS/ICD coding, and coach the claims team. Excellent communication, attention to detail, and the ability to work independently and as part of a team are essential.

Qualifications

• 5 years prior medical, dental, vision, FSA and HRA claims processing experience.
• Strong knowledge of CPT, HCPCS, ICD9 and ICD10 coding.
• Excellent written and verbal communication skills.

Responsibilities

• E1–E13: Ensure claims processed per internal procedures and plan documents; monitor audits to meet turnaround times; maintain workload to quality standards; record results for monthly reporting; coach trainee staff; provide guidance on complex cases; assist with system upgrades and other duties as assigned.

Skills

CPT/HCPCS/ICD9/ICD10 coding

Attention to detail

Problem solving

Verbal and written communication

PC navigation

MS Excel

MS Word

Independent and team player

Education

HS/GED

Associate Degree preferred

Tools

MS Excel

MS Word

Job description

Highmark Health in Cheyenne, WY is seeking a claims audit specialist to ensure accurate processing of medical, dental, vision, FSA and HRA claims, and to monitor audits for timely outcomes.

You will review plan wording, apply CPT/HCPCS/ICD coding, and coach the claims team. Excellent communication, attention to detail, and the ability to work independently and as part of a team are essential.