Get It Recruit – Finance Hiring for Healthcare (Medical) Claims Auditor – Contractor – Remote | WFH at New York, NY Full Time

About Us

We are a technology leader in healthcare process automation and interoperability, committed to creating an open and honest culture. With a global team of over 500 passionate colleagues, we value constant learning and new ideas, fostering an environment where everyone can thrive and contribute.

Responsibilities

As a Healthcare Claims Auditor, you’ll play a crucial role in ensuring the accuracy and completeness of our claim examination process. Your responsibilities will include:

Conducting quality audits for claim edit resolution, correspondence/adjustments, medical review, and data capture.

Managing claim inventory to support ramp up/ramp down and inventory reduction plans.

Researching medical records to set up and terminate work items, completing manual requests for medical records.

Interpreting and applying policy benefits, following desk-level procedures, job aids, and edit resolutions to address urgent claim processing issues.

Tracking, analyzing, and ing findings to claim examiners and department leadership.

Documenting clear and concise audit findings and delivering them to corresponding examiners.

What We’re Looking For

We are seeking candidates with the following qualifications:

Minimum: High School Diploma or equivalent.

Experience using current computer equipment and applications such as laptops and Microsoft Office Suite.

Proficiency with Ten Key and Typing skills.

Intermediate level experience with MS Excel.

3 years of experience in Health Care claim operations.

Knowledge of medical claim forms HCFA, CMS1500, UB04, and ADA.

Knowledge and experience with Medical Code sets ICD 10, HCPCS, CPT, and Modifiers, value codes, type of bill, condition codes, etc.

Preferred Qualifications

Organizational skills and experience prioritizing project work and other tasks.

Experience in the health care industry working with medical insurance, large Health Plan, or Third-Party Administrator.

Why Join Us

Work in a collaborative team environment with opportunities for growth and development.

Contribute to the improvement of departmental operations and overall accuracy.

Be part of an organization that values innovation and embraces new ideas.

Competitive compensation and the flexibility of a remote work environment.

Join us on this exciting journey as we revolutionize healthcare process automation! Apply now to be a key player in our mission to drive scalability and greater efficiency in the industry.

Employment Type: Full-Time