Remote Healthcare Claims Auditor

Mass General Brigham; USA; Remote; USD 24.000 - 35.000; Vollzeit

Benefits dieser Stelle

Remote work eligible

Zusammenfassung

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Claims Analyst to evaluate medical claims, validate ICD-10 and CPT codes, and ensure proper documentation and adherence to billing regulations. The role requires attention to detail, knowledge of medical coding, and strong communication with insurers and patients.

Remote-friendly with standard business hours. The position supports accurate billing, auditing for compliance, and staying current with payer policies to ensure proper

Qualifikationen

• Knowledge of medical billing and coding principles, reimbursement methodologies, and insurance claim submission processes.
• Knowledge of healthcare regulations and HIPAA guidelines.
• Strong attention to detail and accuracy in claim submissions and recordkeeping.
• Excellent communication skills, both written and verbal, with insurance companies, patients, and colleagues.

Aufgaben

• Review and assess medical claims from providers, insurers, and patients to identify discrepancies or potential fraud.
• Analyze and validate ICD-10 diagnosis codes and CPT procedure codes on claims.
• Ensure documentation supports services rendered (physician notes, test results, etc.).
• Analyze claim payments and compare to contracted rates and fee schedules.
• Identify underpayments, overpayments, and billing errors.
• Audit medical claims for compliance with billing regulations and internal policies.
• Stay updated on payer policies and reimbursement rules.

Kenntnisse

Medical billing knowledge

Coding principles

Attention to detail

Communication skills

Ausbildung

High School Diploma or Equivalent

Associate’s Degree preferred

Jobbeschreibung

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Claims Analyst to evaluate medical claims, validate ICD-10 and CPT codes, and ensure proper documentation and adherence to billing regulations. The role requires attention to detail, knowledge of medical coding, and strong communication with insurers and patients.

Remote-friendly with standard business hours. The position supports accurate billing, auditing for compliance, and staying current with payer policies to ensure proper