Senior Medical Claims Processor & Auditor (Remote)

Health Admins, Inc.; Austin, Northern (TX, KY); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Competitive salary

Remote work

Job summary

Health Admins, Inc. is seeking a Senior Claims Processor & Auditor to manage medical claims, perform audits for compliance, and deliver excellent client service.

This role supports claims processing accuracy and coordination with providers and members, in a remote-capable setting in the Austin area. The ideal candidate will possess strong medical terminology and coding knowledge, meticulous attention to detail, and the ability to work independently in a fast-paced environment while maintaining

Qualifications

• High School Diploma or equivalent.
• Proven experience in medical claims processing, auditing, and healthcare reimbursement.
• Strong knowledge of medical terminology and coding.
• Excellent analytical and problem-solving skills.
• Outstanding attention to detail and accuracy in data handling.
• Strong customer service orientation and communication skills.

Responsibilities

• Review and process medical claims promptly and accurately.
• Verify patient demographics, diagnoses, procedures, and billing codes when available.
• Ensure compliance with policies and industry standards.
• Investigate discrepancies in claims submissions.
• Conduct comprehensive audits to identify errors or potential fraud.
• Analyze documentation to ensure coding accuracy and reimbursement.
• Research complex billing issues to support claims processing.
• Interpret guidelines to determine adjudication decisions.
• Provide recommendations to improve submission procedures and accuracy.
• Serve as primary contact for claims inquiries and resolutions.
• Respond to inquiries with professionalism and empathy.
• Collaborate with cross-functional teams to resolve issues.

Skills

Medical terminology

Medical coding

Insurance billing

Analytical thinking

Attention to detail

Customer service

Communication

Independent work

Time management

multitasking

Education

High School Diploma or equivalent

Tools

Salesforce Experience

Google Suite

Claims Management Software

Job description

Health Admins, Inc. is seeking a Senior Claims Processor & Auditor to manage medical claims, perform audits for compliance, and deliver excellent client service.

This role supports claims processing accuracy and coordination with providers and members, in a remote-capable setting in the Austin area. The ideal candidate will possess strong medical terminology and coding knowledge, meticulous attention to detail, and the ability to work independently in a fast-paced environment while maintaining