Senior Medical Claims Auditor & Trainer

Highmark Health; Topeka (KS); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. in Topeka, KS is seeking an experienced Claims Audit Specialist to ensure claims are processed according to internal procedures, review plan wording, and monitor audit workflows.

The role requires 5 years of medical/dental/vision/FSA/HRA claims processing experience, CPT/HCPCS/ICD coding knowledge, and strong communication. Office-based position with competitive pay and benefits.

Qualifications

• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 medical coding.
• Strong attention to details along with organizational skills.
• Excellent problem solving with the ability to work in a fast paced production environment.
• Excellent communication skills both verbal and written.
• PC navigation skills for Professional work environment.
• Basic MS Excel.
• Basic MS Word.
• Ability to use judgement to make sound decisions referencing all available resources.
• Ability to work independently and also as part of a team.

Responsibilities

• Ensure all claims are handled according to internal procedures and review plan wording.
• Monitor workflow of audits to ensure timely turnaround time and meet guidelines.
• Maintain workload in line with quality and production standards.
• Record audit results and create/train staff on issues identified by management.
• Provide guidance to the claims team on questions about processes and audits.
• Assist with system upgrade testing and specialized audits as needed.
• Handle other duties as assigned.

Skills

CPT/HCPCS/ICD coding

Attention to detail

Problem solving

Verbal and written communication

MS Excel

MS Word

Independent worker

Team collaboration

PC navigation

Fast-paced production

Education

HS/GED

Associate degree (preferred)

Job description

Highmark Inc. in Topeka, KS is seeking an experienced Claims Audit Specialist to ensure claims are processed according to internal procedures, review plan wording, and monitor audit workflows.

The role requires 5 years of medical/dental/vision/FSA/HRA claims processing experience, CPT/HCPCS/ICD coding knowledge, and strong communication. Office-based position with competitive pay and benefits.