Certified Medical Claims Auditor (Healthcare)

TL;DR

Certified Medical Claims Auditor (Healthcare): Reviewing medical bills to identify billing discrepancies, unbundled charges, and coding errors with an accent on standard billing practices and coding guidelines. Focus on analyzing complex claim issues, securing additional savings for clients, and mentoring junior analysts in review best practices.

Location: Must be US based

Company

A healthcare platform designed to reduce costs and improve quality for employers, payers, and providers through integrated payment integrity and care management solutions.

What you will do

• Review medical bills to identify appropriate billing, coding, and savings opportunities.
• Analyze and resolve complex claim discrepancies and conduct direct negotiations for billing errors.
• Collaborate with the Negotiation team to secure additional savings and resolve escalated provider inquiries.
• Generate detailed Bill Review Reports for clients and respond to bill reconsideration requests.
• Mentor junior analysts in claim review best practices and support internal training on code changes.
• Ensure strict compliance with HIPAA and other regulatory standards.

Requirements

• Must be US based
• 3+ years of auditing, claims review, or billing experience within a healthcare organization.
• CPC and/or CIC certification.
• Working knowledge of ICD-10, CPT, HCPCS Revenue codes, and CMS guidelines.
• Strong verbal and written communication skills.

Nice to have

• Experience in DRG validation.
• Knowledge of Health Insurance, Medicare guidelines, and various healthcare programs.
• Experience with RevCycle Pro, Encoder Pro, and/or SuperCoder software.

Culture & Benefits

• Comprehensive company-sponsored Medical, Dental, and Vision insurance.
• Financial benefits including 401K with company match and immediate vesting, and HSA/FSA/DCFSA options.
• Generous Paid Time Off, including vacation, sick leave, and paid holidays.
• Paid maternity and paternity leave.
• Flexible remote working environment with company-provided equipment.
• Additional perks such as pet insurance and employee discounts on phone plans and computers.