Internal Claims Auditor, Remote

6 days ago

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

💵 $19 - $21 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Guide Healthcare

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Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.

Physiotherapy • Podiatry • Speech Pathology • Dietetics • Recruitment

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

🎯 Recruitment

📋 Description

• 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.

🎯 Requirements

• 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