Compliance Medical Claims Auditor

Compliance Medical Claims Auditor Responsibilities: • Support internal and external claims auditing efforts, including an assessment of: • Claims accuracy • Eligibility • Accumulation • Pricing • Plan Design Adherence • Coding/Diagnosis decision-making • Assist with responses provided to third-party auditors including preparatory review of sample claims, discussion responses, and review of draft audit reports • Independently perform claims accuracy reviews targeting high-risk areas or work plan items to determine compliance and financial accuracy • Review internal coding/claims processing efforts to provide recommendations related to regulatory and plan requirements • Draft audit reports resulting from claims compliance reviews Qualifications: • Significant health care claims experience and health claims rev cycle • Familiarity with EDI files • Knowledge of CORE standards (837/835s) • CCS Certified (Inpt/outpt) or CPC with Facility (837I) experience • Coding Expertise (inpt/outpt, assignment of benefits) • CPT/HCPCS/ICD-10/Revenue Codes • Knowledge of NUCC/NUBC • X-12 CARC/RARC Claims adjustment reason code knowledge • NCPDP Claims (Retail Pharmacy & DME) Compensation: $50 - $70 per hour ID#: 2335 Cypress HCM, LLC www.cypresshcm.com (415) 394 – 6400 Apply Job! Apply to this Job