Remote Claims Auditor: Compliance, QA & Process Impact

SCAN; United States; Remote; USD 35.000 - 51.000; Vollzeit

Benefits dieser Stelle

Remote work

Annual bonus program

Wellness program

PTO

Eleven paid holidays

401(k) match

Tuition reimbursement

Zusammenfassung

SCAN Health Plan seeks a detail‑oriented Claims Auditor to conduct pre‑ and post‑pay audits, ensuring accurate payments and CMS compliance. The role requires experience with Medicare/Medicaid claims, and knowledge of CMS requirements, DOFR/COB, and automated processing systems.

Ideal candidates will have an Associate's degree (or equivalent) and 3+ years in complex claims processing, with proficiency in IKA and QNXT. Remote work is offered with a strong wellness and bonus program.

Qualifikationen

• Associate's degree or equivalent experience preferred.
• 3+ years in complex claims processing and/or auditing in health plan or managed care.
• Proficient in Medicare/Medicaid claims processing.

Aufgaben

• Perform pre-pay and post-pay audits to ensure accurate payments.
• Ensure regulatory compliance and quality using CMS standards.
• Work with other units to correct processing errors before final payment.
• Follow policies; communicate improvement recommendations to management.

Kenntnisse

Claims auditing

Medicare/Medicaid

CMS regulations

DOFR/ COB

Coding systems CPT4 ICD9 ICD10 DRG HC…

IKA / QNXT

Health insurance training

Institutional & Professional claims

Ausbildung

Associate's degree or equivalent

Tools

IKA

QNXT

Jobbeschreibung

SCAN Health Plan seeks a detail‑oriented Claims Auditor to conduct pre‑ and post‑pay audits, ensuring accurate payments and CMS compliance. The role requires experience with Medicare/Medicaid claims, and knowledge of CMS requirements, DOFR/COB, and automated processing systems.

Ideal candidates will have an Associate's degree (or equivalent) and 3+ years in complex claims processing, with proficiency in IKA and QNXT. Remote work is offered with a strong wellness and bonus program.