Claims Auditor

Medix

(Phoenix, Arizona)
Full Time
Job Posting Details
About Medix
Medix provides workforce solutions to clients and creates opportunity for contract employees representing a variety of industries through our Healthcare, Scientific and Information Technology divisions.
Summary
As a Claims Auditor, you will be responsible for securing data integrity and working accuracy standards by auditing claims and provider demographic information. This position conducts weekly adjudicated claims audit for all forms of claim types: UB04s, Dental, and HCFA 1500’s.
Responsibilities
* Assure the quality of work within the organization. * Perform random quality audits of claims processed. * Conduct financial accuracy audits on all claims paid greater than a value of $2,500.00. * Perform audits of provider demographics information and contracts. * Analyze and document audit results. * Maintains, communicates, track, and trend audit results and report finding. * Support the audit needs of the organization. * Complete ad-hoc analysis and reports upon request. * Prompt identification and communication of recognized trends and/or issues. * Facilitates opportunities to develop and implement process improvement. * Research new Medicaid, CMS, and Commercial rules and guidelines. * Provides feedback to Claims, Network, and Information System departments of findings to improve quality.
Ideal Candidate
* As a Claims Auditor you must be a reliable, quick learner with attention to detail and the ability to meet metrics. * Knowledge of medical terminology. * Knowledge of ICD-9/ICD-10 (when applicable). * Knowledge of CPT/HCPC/ICD9/ICD10 coding. * Substantial knowledge of Medicaid, CMS, and commercial coverage regulations and guidelines. * Claims processing. * Data entry skills. * Strong analytical skills. * Detail oriented. * Computer experience required, including MS Access, Excel, Word, and PowerPoint. * Ability to analytically and logically resolve issues and interpret findings. * Ability to solve problems. * Effective interpersonal and communication skills.

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