Medical Claims Auditor: Coding & Compliance Expert

Arizona Priority Care; Chandler (AZ); On-site; USD 32,000 - 36,000; Full time

Job summary

Arizona Priority Care in Chandler, AZ seeks a Medical Claims Auditor to review claims for completeness and compliance. You will ensure accurate adjudication using CPT, HCPCS, ICD-9 codes and plan documents, with emphasis on high-dollar and network claims, while maintaining quality and production standards.

The role requires at least 5 years of claims experience, meticulous attention to detail, and in-office presence for the first 60 days; hybrid work may follow after training.

Qualifications

• High school diploma or GED required.
• Minimum 5 years of recent claims experience.
• Claims auditing experience preferred.
• Knowledge of CPT, HCPCS, ICD-9, and DSM codes.
• Familiarity with CMS guidelines, DHS regulations, and Medicare billing.
• Experience with UB-92 forms is desired.
• Strong data entry skills (high keystroke volume).
• Ability to work independently and use multiple computer systems.

Responsibilities

• Audit completed claims for all products and ensure daily self-audit reports.
• Adjudicate claims following policies to ensure proper payment.
• Verify member benefits and COB during eligibility research.
• Review authorization status codes and notes affecting adjudication.
• Audit high-dollar and network specialty claims.
• Apply provider contract rates based on dates and amendments.
• Maintain production and quality scores for team members.
• Assist with training on contract application and adjudication policies.
• Produce periodic post-audit reviews to correct decisions.

Skills

Attention to detail

Data entry

Medicare billing knowledge

Independent work

Computer systems proficiency

Education

High school diploma or GED

Tools

EzCap

UB-92 forms

Job description

Arizona Priority Care in Chandler, AZ seeks a Medical Claims Auditor to review claims for completeness and compliance. You will ensure accurate adjudication using CPT, HCPCS, ICD-9 codes and plan documents, with emphasis on high-dollar and network claims, while maintaining quality and production standards.

The role requires at least 5 years of claims experience, meticulous attention to detail, and in-office presence for the first 60 days; hybrid work may follow after training.