Claims Auditor & Coding Specialist — Quality & Compliance

Planned Systems International, Inc.; United States; On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Paid leave

401(k) retirement plan with employer match

Tuition reimbursement programs

Job summary

Planned Systems International, Inc. is seeking a Claims Auditor, Reviewer and Coder to provide expertise in quality assurance and claims processing. This role involves supporting the WTC Health Program by analyzing claims data, conducting audits, and ensuring accurate application of medical coding standards.

The ideal candidate will have a degree in health professions and at least 5 years of experience in medical coding and claims auditing, along with proficiency in MS Office. Comprehensive benefits and professional growth opportunities are offered.

Qualifications

• Minimum 5 years' experience with health insurance payor claims data.
• Expertise in CPT, HCPCS, and ICD billing codes.
• Registered Health Information Administrator (RHIA) or similar certification desirable.

Responsibilities

• Support the development of the WTC Health Program’s Quality Assurance Plan.
• Analyze claims data to identify issues, trends, and patterns.
• Interface with clinicians and federal staff for audit activities.

Skills

Quality assurance expertise

Claims processing

Medical coding

Audit activities

Data analysis

Education

Bachelor's or Master's degree in a health profession

Tools

Microsoft Office Suites

Teams

SharePoint

Job description

Planned Systems International, Inc. is seeking a Claims Auditor, Reviewer and Coder to provide expertise in quality assurance and claims processing. This role involves supporting the WTC Health Program by analyzing claims data, conducting audits, and ensuring accurate application of medical coding standards.

The ideal candidate will have a degree in health professions and at least 5 years of experience in medical coding and claims auditing, along with proficiency in MS Office. Comprehensive benefits and professional growth opportunities are offered.