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Medical Claims Auditor (Quality Control Analyst)

Job Description

Claims Auditor / Quality Control Analyst
Managed Care (Office)

  1. Audits claims to identify examiner and system errors. Research and resolve. 
  2. Maintains a solid working knowledge of Health plan and provider contracts, division of responsibility (DOFR), and CPT/ICD9 coding. 
  3. Audits daily professional and facility claims 
  4. Flags claims for examiner errors. 
  5. Researches system configuration against contracts and flag claims for system configuration errors. 
  6. Calculates drug claims 
  7. Audits and tests system configuration changes or new client implementations 
  8. Reviews daily audit reports and takes appropriate actions. 
  9. Performs retrospective audits identifying over payments, underpayments and system configuration issues. 
  10. Identifies any inappropriate provider billing issues. 
  11. Maintain proper accounting records, back up and reports 

Job Requirements

  • 2+ years experience in professional and institutional claims examining and/or auditing. 
  • Excellent knowledge of CPT, RBRVS, DRG, HCPCS and ICD-9 coding and regulations.

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Insurance
Education Not Specified
Experience At least 3 year(s)
Manages Others No
Industry Managed Care, Healthcare - Health Services
Required Travel None
Job ID 13A*
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Medical Claims Auditor (Quality Control Analyst)

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