Certified Medical Claims Auditor (Healthcare)

TL;DR

Certified Medical Claims Auditor (Healthcare): Reviewing medical claims to identify billing discrepancies, unbundled charges, and savings opportunities with an accent on coding accuracy and regulatory compliance. Focus on analyzing complex claim issues, mentoring junior analysts, and collaborating with internal teams to improve billing processes and client outcomes.

Location: Must be US based

Company

hirify.global is a healthcare platform dedicated to simplifying the patient journey and reducing costs through integrated solutions for employers, payers, and providers.

What you will do

• Review medical bills to identify appropriate billing, coding, and savings opportunities.
• Analyze and resolve complex claim discrepancies beyond initial review.
• Communicate findings to clients through detailed reports and assist with inquiries.
• Handle escalated provider disputes and conduct direct negotiations.
• Mentor junior analysts and contribute to policy and process improvements.
• Ensure compliance with HIPAA and other regulatory standards.

Requirements

• Must be US based to comply with company policies and HIPAA.
• 3+ years of auditing, claims, review, or billing experience in a healthcare organization.
• CPC and/or CIC certification required.
• Working knowledge of industry coding, ICD-10, CPT, HCPCS, and Revenue codes.
• Strong understanding of CMS guidelines.
• Excellent 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, or SuperCoder software.

Culture & Benefits

• Generously subsidized Medical, Dental, and Vision insurance.
• 401K with company match and immediate vesting.
• Flexible working environment with provided equipment.
• Generous Paid Time Off including vacation, sick leave, and holidays.
• Paid maternity and paternity leave.
• Employee Assistance Program and pet insurance.