Claims Auditor I

ttg Talent Solutions, Inc.; Town of Florida (NY); On-site; USD 32,000 - 36,000; Full time

Job summary

ttg Talent Solutions, Inc. is seeking a detail-oriented Claims Auditor I to perform pre- and post-payment audits within a managed care healthcare environment.

This on-site role is based in Doral, FL and supports CMS Medicare guideline compliance while identifying discrepancies and opportunities for process improvement. Ideal candidates have at least five years of claims processing experience and one year of quality or claims auditing experience, plus knowledge of CPT, HCPCS, ICD-10 coding and

Qualifications

• 5+ years of claims processing experience
• 1 year of quality audit or claims auditing experience
• Medicare/CMS experience preferred
• Knowledge of medical terminology and coding (CPT/HCPCS/ICD-10)

Responsibilities

• Perform pre- and post-payment audits, including high-dollar/complex Medicare claims
• Review underpayment disputes and claims examiner work for accuracy
• Validate eligibility, pricing, reimbursement, authorizations, and medical necessity
• Interpret CMS requirements, medical policies, and reimbursement guidelines
• Document audit findings, discrepancies, financial impact, and system errors
• Track audit trends, identify root causes, and recommend corrective actions
• Provide feedback to claims teams and collaborate with internal departments
• Identify potential overpayment and recovery opportunities
• Maintain required audit volumes and turnaround times

Skills

Claims processing

Healthcare knowledge

Attention to detail

Analytical thinking

Education

High School Diploma or GED

Tools

CPT coding

HCPCS coding

ICD-10 coding

Job description

CLAIMS AUDITOR I

LOCATION: Doral, FL 33178

TYPE: On-site

TYPE OF CONTRACT: Temp to Perm

PAY RATE: $23.00 - $26.00 per hour

DESCRIPTION:

We are seeking a detail-oriented Claims Auditor I to perform pre- and post-payment audits within a managed care healthcare environment. This role ensures claims accuracy, regulatory compliance, and adherence to CMS Medicare guidelines while identifying discrepancies and opportunities for process improvement.

Key responsibilities include:

• Perform pre- and post-payment audits, including high-dollar and complex Medicare claims.
• Review underpayment disputes and claims examiner work for accuracy and compliance.
• Validate eligibility, coding (CPT, HCPCS, ICD), pricing, reimbursement, authorizations, and medical necessity.
• Interpret CMS requirements, medical policies, and reimbursement guidelines.
• Document audit findings, discrepancies, financial impact, and processing or system errors.
• Track audit trends, identify root causes, and recommend corrective actions and process improvements.
• Provide feedback to claims teams and collaborate with internal departments to resolve complex issues.
• Identify potential overpayment and recovery opportunities.
• Maintain required audit volumes and turnaround times.

REQUIREMENTS:

• High School Diploma or GED required.
• Minimum 5 years of claims processing experience, preferably in healthcare or insurance.
• At least 1 year of quality audit or claims auditing experience.
• Medicare/CMS and managed care experience strongly preferred.
• Knowledge of medical terminology, claims systems, CPT, HCPCS, and ICD-10 coding.
• Understanding of claims adjudication, reimbursement methodologies, and audit practices.
• Strong analytical, research, problem-solving, and attention-to-detail skills.
• Ability to work independently, manage priorities, and meet deadlines.
• Effective written and verbal communication skills.
• Experience with underpayment disputes or payment integrity functions preferred.
• Equivalent combinations of education and experience may be considered.

At ttg, "We believe in making a difference One Person at a Time," ttg OPT.