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Medical Claim Auditor Jobs

Senior Stoploss Claim Auditor (Remote)
By BlueCross BlueShield of South Carolina At Miami-Fort Lauderdale Area, United States
Communicate effectively with carriers, vendors, and management. Provide full claims service to both phone and written inquiries.
Knowledge of group insurance, managed care and direct medical claims products.
Knowledge in COB, Medicare, HIPAA, CPT, ICD-9 and benefit plan interpretation.
Two years of medical claims and/or reinsurance claims experience.
Six years of medical claims and/or reinsurance claims experience.
Prior Stop Loss insurance experience.
Intake Counselor - Medical Claim Appeals (On-Site)
By Denials Management Inc. At Salt Lake City, UT, United States
Previous insurance or healthcare experience in a client-facing or customer service role
Working knowledge of English composition and grammar
Demonstration of critical thinking skills
Previous experience working with digital documentation
Previous experience with professional email correspondence
Prior customer service experience, minimum 1 year
Medical Billing – Claim Prep And File - Remote | Wfh
By Get It Recruit - Healthcare At West Plains, MO, United States

We are seeking an enthusiastic and compassionate individual to join our dynamic Medical Billing - Claim Prep and File - Call Team. In this role, you will have the opportunity to engage with patients ...

Remote - Medical Claim Coordinator (Cpc Certified)
By TalentBridge At South Carolina, United States
Utilize multiple systems, such as SharePoint, Salesforce, and Microsoft Office Products, to perform job duties effectively.
Associate's Degree from an accredited college or university or equivalent experience
At least two (2) years of experience in a medical billing, claims processing, or related position required
Experience with ICD-10 and CPT codes.
Remote - Medical Claim Coordinator (ICD-10 Certified)
Review and analyze case file materials related to claims payment disputes.
Medical Claim Specialist Jobs
By Allied Benefit Systems At United States
Applicants must have strong analytical skills and knowledge of computer systems.
Review Workflow Manager daily to document and release pended claims, if applicable.
Attend continuing education classes as required, including but not limited to HIPAA training.
Continuing education in all areas affecting group health and welfare plans is required.
Applicants must have a minimum of two (2) years of medical claims analysis experience (Medicare/Medicaid does not count towards the experience).
Prior experience with a Third-party Administrator is highly preferred.
Medical Review Auditor Analyst (Remote)
By Conduent At United States
Assessing payments against regulatory or administrative charges, coding, and billing errors. Determining if fraud or inaccurate billing has occurred.
Preparing written case summaries and represents clients and Conduent as an expert witness
Developing, maintaining, and ensuring adherence to multiple project schedules.
Achieving percent of savings expectations through their review billing
Ensuring productivity goals are met daily and communicating audit findings to clients.
Participating in planning, daily meetings, and backlog sessions
Claim Manager Jobs
By Beazley At , $102,000 - $216,000 a year
Work management skills: Time and workload management, Self-starter, Planning, Achievement orientation, Productivity focus
Interpersonal skills: Ability to influence others, Client and broker management skills, Purposeful communication, Flexibility, Active listening
Identification of issues and trends in the portfolio, consult management/peers if required, and take appropriate and/or corrective action.
Adhere to Beazley’s procedures for the selection and retention of 3rd party professionals and manage relationships to the benefit of Beazley.
Ensure the management of claims conforms to the agreed standardised processes and use of
Support the Claims Business Management Team and Claims Solutions Team to identify and implement business performance improvement opportunities.
Medical Auditor Jobs
By CareMax, Inc. At Miami, FL, United States
Ability to speak effectively with employees, Providers, clinical staff visitors and management
Access to continual education through CareMax University
Minimum three years of coding, billing and audit/chart review experience is required. Medical Coder II or III
Medicare Advantage, Medicaid, and outpatient coding experience or equivalent.
Working knowledge of billing for a multi-discipline practice and general computer systems required
Collaborating with providers to clarify diagnoses, procedure coding, and documentation requirements, including proper sequencing, to ensure accuracy and compliance with regulations.
Medical Claims Auditor Jobs
By Imagine360 At United States
Elevate complex claim issues for clinician or management review
Facilitate financing of approved claims with finance
5+ years' experience in medical claims administration (carrier or provider); Understanding of medical Third Party Administration functions preferred
Knowledge of medical terminology required
Working knowledge of computers and software including but not limited to Microsoft Office products
Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
Clinical Claim Review Rn - Medical Disability - Remote
By UnitedHealth Group At , Phoenix, 85002, Az $56,300 - $110,400 a year
Proficient computer skills including Microsoft Office programs and database experience
Remain up to date with the contract requirements
3+ years of experience in a clinical environment as a Registered Nurse
Understanding/knowledge of regulatory standards and their application to various examinations and documents
Experience working in an Electronic Medical Record system
Excellent verbal and written communication skills
Claim Assistant Jobs
By Sunrise Systems, Inc. At Houston, TX, United States
Professional organizational skills and the ability to effectively manage multiple priorities
Input data entry correspondence into system, diaries information for claims reps and/or team leader and prepares form letters
Professional written and oral communication skills including effective telephone skills
Demonstrated initiative as evidenced by the ability to self-manage, organize and prioritize work
Strong working knowledge of computer systems and various Microsoft applications such as Word and Outlook
Receive new losses and verifies accuracy of information via coverage
Medical Claim Review Nurse (Rn)
By Molina Healthcare At , Long Beach, 90802, Ca

To all current Molina employees: