A company is looking for a Claims Auditor.
Key Responsibilities
Conduct pre-check run auditing on various reports prior to finalizing the check run, managing timelines effectively
Assist with Health Plan claim audits and provide feedback to management and staff regarding results
Complete Claims Appeals and 095 processes according to health plan and company guidelines within established timeframes
Required Qualifications
Bachelor's degree or equivalent experience required
4-5 years of experience in claim processing
Specific knowledge of claims and processes in a Commercial BC / BS HMO organization
Extensive knowledge of CPT 4, HCPCS, UB-04, and ICD-10 coding
Medical terminology knowledge
Claims Auditor • Astoria, New York, United States
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