Remote Medical Claims Auditor - Coding & Denials Expert

Gainwell Technologies LLC; Austin (TX); Teletrabalho; USD 50 000 - 55 000; Tempo integral

Resumo da oferta

Gainwell Technologies LLC is seeking a Medical Claims Auditor to review and analyze medical claims for accuracy and compliance. You will validate coding with ICD-10, CPT, and HCPCS guidelines and interpret EOBs and UB-04 forms to ensure correct billing.

In this remote Texas role, you will identify discrepancies such as duplicates, upcoding, or unbundling, communicate findings to the claims team, and support CMS, Medicaid, and payer contract guidelines to improve claim integrity and reduce errors.

Qualificações

• HS Diploma/GED; 3+ years of direct medical claims experience.
• Strong knowledge of insurance types (HMO, PPO, EPO, Medicare, Medicaid) and claims lifecycle.
• Advanced understanding of EOBs and UB-04/HCFA-1500 forms.
• Experience navigating payer portals and health information systems (Availity, Navinet).
• Ability to perform high-volume outreach (30+ daily contacts) to resolve denials and recoveries.

Responsabilidades

• Review medical claims, supporting documentation, and medical records for accuracy and compliance.
• Validate coding accuracy using ICD-10, CPT, and HCPCS guidelines.
• Interpret and analyze EOBs and UB-04 claim forms to verify correct billing data.
• Identify and document discrepancies such as duplicate claims, unbundled services, upcoding and other errors.
• Communicate audit findings and recommend corrective actions to the claims processing team or management.
• Apply CMS, Medicaid, Medicare, and payer contract guidelines to ensure claims integrity; support process improvements.

Conhecimentos

Attention to detail

Auditing

Communication

Denials management

Formação académica

HS Diploma/GED

Ferramentas

Availity

Navinet

Descrição da oferta de emprego

Gainwell Technologies LLC is seeking a Medical Claims Auditor to review and analyze medical claims for accuracy and compliance. You will validate coding with ICD-10, CPT, and HCPCS guidelines and interpret EOBs and UB-04 forms to ensure correct billing.

In this remote Texas role, you will identify discrepancies such as duplicates, upcoding, or unbundling, communicate findings to the claims team, and support CMS, Medicaid, and payer contract guidelines to improve claim integrity and reduce errors.