Remote Medical Claims Auditing

Guidehealth; Missouri City (MO); Remote; Full time

Job summary

Guidehealth, a leading healthcare company, is seeking an experienced professional to ensure compliance and accuracy in claims processing. The ideal candidate will have a strong background in healthcare auditing and analytics, with a focus on delivering high-quality services. Join a remote team dedicated to improving patient outcomes and operational excellence.

Benefits

Work from Home

Comprehensive Medical, Dental, and Vision plans

401(k) plan with employer match

Life and Disability insurance

Flexible Time Off

Paid parental leave

Employee Assistance Program (EAP)

Professional growth resources

Qualifications

• Minimum 3 years experience in healthcare or managed care industry.
• 1-3 years auditing experience in the healthcare industry.
• Advanced proficiency in Microsoft Office products.

Responsibilities

• Ensure accuracy of claims processing and contract logic builds.
• Perform targeted audits of claims processing.
• Run access queries for administrative purposes.

Skills

Problem Solving

Communication

Data Analysis

Education

Bachelor’s degree in healthcare informatics

Tools

Microsoft Office

Job description

Company Description

WHO IS GUIDEHEALTH?

Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealthleverages remotely-embedded Healthguides and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealthempowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

Join us as we put healthcare on a better path!!

Job Description

WHAT YOU’LL BE DOING

• Understand and stay current with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations.
• Ensure accuracy of claims processing and contract logic builds through internal audit processes.
• Perform targeted audits of claims processing including, but not limited to, high dollar payments, benefit matrix, interest payments, pre-payment and post-payment audits, and multiple procedure claims.
• Perform quality audits of claims staff, eligibility staff, and system logic.
• Perform audits of new client setup in the claims processing software.
• Run access queries as needed for administrative purposes.
• Other duties and responsibilities as assigned.
  
  

Qualifications

What You'll Need To Have

• Minimum 3 years of experience in the healthcare or managed care industry, including claims/reimbursement experience, professional analytics-related experience and experience working on/managing major projects
• 1-3 years auditing experience in the healthcare industry
• Advanced to expert proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access
• Able to problem solve, exercise initiative, and make low to medium level decisions
• Thorough understanding of current federal, state and local healthcare compliance requirements
• Ability to meet deadlines and prioritize tasks; collect, correlate, and analyze data
• Ability to work independently with minimal supervision and as part of a team
• Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player
• Effective written and oral communication
  
  

WOULD LOVE FOR YOU HAVE

• Bachelor’s degree in healthcare informatics, business administration, or related field, or equivalent in experience and education
• Certified Professional Coder strongly recommended
• Prior claims processing experience within Eldorado HealthPac Claims Adjudication System is a plus
• Claim coding experience, coding edits experience and APC Pricing knowledge
• CPT and ICD coding knowledge
  
  

Additional Information

The base pay range for this role is between$21-$24per hour, paid bi-weekly

All your information will be kept confidential according to EEO guidelines.

ALIVE with Purpose: How We Thrive at Guidehealth

At Guidehealth, our values come to life in everything we do.

We are Driven by Accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.

Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a better future for healthcare.

With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve.

At Guidehealth, Every Voice Matters — we believe our collective strength is rooted in the unique perspectives of each team member.

And through Empathy in Action, we build stronger connections with those who count on us.

This is what it means to be ALIVE with purpose. This is how we thrive — together — at Guidehealth.

BENEFITS:

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.
  
  

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices.Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

Our Comittment To Protection Of Patient And Company Data

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

Remote Work Technical Requirements

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test hereto confirm your internet connection meets these requirements.