Remote Medical Claims Auditor

Gainwell Technologies LLC; Clifton (TX); Remote; USD 50,000 - 55,000; Full time

Benefits offered by this job

Flexible vacation policy

Educational assistance

Leadership academies

Job summary

Gainwell Technologies is seeking a Medical Claims Auditor to review and analyze medical claims for accuracy, compliance, and payer adherence. You will audit provider-submitted claims, validate coding accuracy, and identify errors in submissions to support high-quality claim processing.

Remote position in Texas; candidates expected to work Monday–Friday with standard hours and use payer portals like Availity and Navinet to resolve denials and support reimbursement outcomes while adhering to CMS,

Qualifications

• HS Diploma or GED required.
• Minimum of three years' direct medical claims collections experience.
• Strong knowledge of insurance policy types (HMO, PPO, EPO, Medicare, Medicaid) and the claims lifecycle.
• Advanced understanding of EOBs and UB-04/HCFA-1500 forms.
• Experience navigating payer portals (Availity, Navinet).
• Ability to perform high-volume outreach (30+ daily contacts) to resolve denials and recoveries.

Responsibilities

• Review medical claims, documentation, and records for completeness and compliance.
• Validate coding accuracy using ICD-10, CPT, and HCPCS guidelines.
• Interpret and analyze EOBs and UB-04 to verify billing data.
• Identify and document discrepancies such as duplicates and upcoding.
• Communicate audit findings and recommend corrective actions to the team.
• Apply CMS, Medicaid, Medicare and payer contract guidelines to ensure integrity.
• Support process improvements to reduce billing errors.

Skills

HS Diploma

3+ years claims

Insurance policy types

EOBs & UB-04

Payer portals

High-volume outreach

Education

HS Diploma / GED

Tools

Availity

Navinet

Job description

Gainwell Technologies is seeking a Medical Claims Auditor to review and analyze medical claims for accuracy, compliance, and payer adherence. You will audit provider-submitted claims, validate coding accuracy, and identify errors in submissions to support high-quality claim processing.

Remote position in Texas; candidates expected to work Monday–Friday with standard hours and use payer portals like Availity and Navinet to resolve denials and support reimbursement outcomes while adhering to CMS,