Remote Claims Auditor: Ensure Accurate Medicare/Medicaid Payments

SCAN Health Insurance; United States; Remote; USD 35,000 - 51,000; Full time

Benefits offered by this job

Annual bonus program

Wellness program

Generous PTO

Holidays and time off

401(k) retirement plan with match

Job summary

SCAN Health Insurance is seeking a Claims Auditor to perform pre-pay and post-pay audits ensuring accurate payments and denials. The role requires strong CMS knowledge, claims processing expertise, and collaboration across the Claims Department.

You will work remotely with a focus on regulatory compliance, quality, and process improvements, while maintaining high service levels for internal customers and providers.

Qualifications

• Associate’s degree preferred or equivalent experience.
• 3+ years complex claims processing and/or auditing experience with a health plan, healthcare, or managed care organization.
• Proficient in processing/auditing claims for Medicare and Medicaid plans.
• Knowledge of CMS requirements regarding claims processing.
• Working knowledge of DOFR (Division of Financial Responsibility) and COB (Coordination of Benefits).
• Current experience in both Institutional and Professional claim payment.
• Knowledge of CPT4, ICD9, ICD10, DRG and HCPCS coding; health insurance terminology.

Responsibilities

• Perform pre-pay and post-pay audits to ensure accurate claims payments and denials.
• Ensure regulatory compliance and quality by applying knowledge of claims processing standards.
• Work cases through SCAN's workflow system and track status.
• Document audits with detail for clear final resolutions.
• Collaborate with Claims Department to review processing errors before final payment.
• Follow policies to maintain efficient operations and propose process improvements.
• Adhere to applicable Federal and State regulations and guidelines.
• Provide high-quality customer service to internal customers and meet team expectations.
• Escalate issues to management as required and support ad-hoc audits.

Skills

Claims processing

CMS requirements

DOFR and COB

Medical coding knowledge

I KA / QNXT systems

Education

Associate degree preferred

Tools

IKA

QNXT

Job description

SCAN Health Insurance is seeking a Claims Auditor to perform pre-pay and post-pay audits ensuring accurate payments and denials. The role requires strong CMS knowledge, claims processing expertise, and collaboration across the Claims Department.

You will work remotely with a focus on regulatory compliance, quality, and process improvements, while maintaining high service levels for internal customers and providers.