Stop Loss Claims Auditor

Imagine360

1d • Remote

About The Position

Imagine360 is currently seeking a Medical Billing Auditor to join our team! The Medical Auditor is responsible for auditing medical facilities and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. Candidate must possess a strong understanding of Medicare and Medicare guidelines. Must display a high degree of independent judgement and professional skepticism that enhances the work performed in order to achieve success in this position.
Position Location: 100% remote

Requirements

• High School Diploma or equivalent
• Minimum 2 years Claims Coding or Medical Billing experience
• Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms
• AAPC Certification and ICD-10 Proficient is required

Nice To Haves

• Medicare Reimbursement / Denial experience preferred
• Prior experience in the Self-Funded Industry is desired

Responsibilities

• Review medical facility and professional claims for accuracy and apply standard coding rules, guidelines and conventions
• Enter billing information into the appropriate report format for the client requesting the work
• Review contracts and is able to apply contractual adjustments to the medical charges
• Audit charges for CPT coding and compliance with state and federal regulations
• Process and Access coding patterns and be able to identify signs of fraud and abuse
• Review medical records to verify accurate coding
• Ensure accuracy of work product
• Proficient in meeting quality and quantity standards
• Able to learn and properly utilize proprietary software programs essential to support the job function.
• Adhere to HIPAA guidelines and regulations
• Perform additional duties assigned by management.

Benefits

• Multiple Health Plan Options
• Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED