Senior Medical Claims Examiner/Auditor

Our client is looking for experienced Medical Claims Examiners and Auditors for immediate, long term needs.

Medical
Dental
Vision
401k
4/10 shifts (either Monday or Friday off weekly)

Job Details:

We are currently seeking a dynamic and experienced Senior Medical Claims Examiner/Auditor to join our team. The successful candidate will play a critical role in examining and auditing medical claims to ensure accuracy and compliance. This role requires an individual with a strong background in the healthcare industry, specifically with medical claims examining and auditing. The individual will work closely with our sales team, contributing to the growth and success of our company. This is an exceptional opportunity to join a fast-paced, growing organization that values innovation, creativity, and performance.

Responsibilities:

1. Conduct comprehensive reviews of medical claims to validate accuracy and ensure compliance with industry standards and regulations.
2. Utilize expertise in ICDA9, CPT coding to evaluate the appropriateness of the services, procedures, and diagnoses provided in healthcare claims.
3. Identify and investigate suspicious claims and potential fraudulent activity, working closely with the fraud investigation team.
4. Provide detailed audit findings and recommendations for improvement to management and sales team.
5. Collaborate with sales team to provide insights and recommendations for enhancing the sales strategy.
6. Train and mentor junior claims examiners and auditors, fostering an environment of continuous learning and improvement.
7. Stay updated on latest industry trends, regulations, and best practices related to medical claims examining and auditing.

Qualifications:

1. Minimum of 3 years of experience in medical claims examining and auditing, preferably in the sales industry.
2. Proficient in icda9, CPT coding, and other relevant medical coding systems.
3. Strong analytical skills with the ability to identify discrepancies and anomalies in data.
4. Excellent communication skills, with the ability to clearly present complex information to both technical and non-technical stakeholders.
5. Proven leadership skills, with experience in training and mentoring junior staff.
6. Strong understanding of healthcare industry regulations and standards.
7. Detail-oriented with strong organizational and multitasking skills.
8. Proficiency in using Microsoft Office Suite and claims management software.
9. Certified Professional Coder (CPC) or Certified Medical Auditor (CMA) certification is a plus.

This is a fantastic opportunity for a seasoned professional looking to make an impact in a dynamic, growing company. If you are a detail-oriented, analytical thinker with a passion for healthcare and sales, we would love to hear from you.