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Medical Claims Auditor - Irving, TX

Description

The CSI Companies, Inc, a leading National Professional staffing agency is currently hiring multiple Medical Claims Auditors in the Irving, TX area. This role identifies healthcare overpayments and underpayments to providers and customers. CSIORL

The ideal candidate has medical billing/coding and claims processing experience and is familiar with the denial and appeals process.

Duration: Long term contract into 2021, with potential to go permanent

Schedule: Full time, business hours.
 

Pay: $22.19/hr

Essential Responsibilities:

  • Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements.
  • Applies knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new overpayment recovery opportunities.
  • Works with data miners, clinical staff, and stakeholders to identify new overpayment issues for each client.
  • Tracks, and follows-up on results and recoveries
  • Contributes new ideas for improving existing audit processes and audit queries. Works cohesively with the audit team.
  • Develops, maintains, and ensures adherence to multiple project schedules

Preferred Knowledge, Skills and Abilities:

  • Ability to effectively interface with clients on the phone and in person
  • Working knowledge of Microsoft Suite of products (Excel, Word, Access)
  • Sound understanding or medical terminology and anatomy.
  • Good understanding of Medicaid required, Medicare and commercial experience a plus.
  • In depth knowledge of coding principals including but not limited to NCCI Edits, CPT, HCPCS and ICD-9 codes and modifiers; and/or MSDRG, Revenue codes, and APCs.
  • In depth knowledge of UB04 and medical (1500) claim formats and requirements.

Minimum Education:

  • High School Diploma or GED required – will be verified

Minimum Related Work Experience: :

  • 1-3 years of healthcare reimbursement experience such as provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing, and/or revenue cycle improvement required.
  • Must have demonstrated experience and knowledge of healthcare claims processing (Medicaid, Medicare, Commercial Insurance), including ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, etc. preferred.
  • Experience in healthcare auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred.
  • Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience a plus preferred

Requirements

 

Job Snapshot

Location US-TX-Irving
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
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Company Overview

The CSI Companies

The CSI Companies and its four divisions provide national staffing solutions by placing top talent in the technology, financial, accounting, healthcare, and other professional industries across the country. The CSI Companies are part of Recruit Global Staffing, active in Asia, Europe, North America and Oceania. Recruit Global Staffing is a leading global HR service provider, part of Recruit Holdings Co., Ltd. To learn more about The CSI Companies, visit thecsicompanies.com. Learn More

Contact Information

US-TX-Irving
Snapshot
The CSI Companies
Company:
US-TX-Irving
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Description

The CSI Companies, Inc, a leading National Professional staffing agency is currently hiring multiple Medical Claims Auditors in the Irving, TX area. This role identifies healthcare overpayments and underpayments to providers and customers. CSIORL

The ideal candidate has medical billing/coding and claims processing experience and is familiar with the denial and appeals process.

Duration: Long term contract into 2021, with potential to go permanent

Schedule: Full time, business hours.
 

Pay: $22.19/hr

Essential Responsibilities:

  • Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements.
  • Applies knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new overpayment recovery opportunities.
  • Works with data miners, clinical staff, and stakeholders to identify new overpayment issues for each client.
  • Tracks, and follows-up on results and recoveries
  • Contributes new ideas for improving existing audit processes and audit queries. Works cohesively with the audit team.
  • Develops, maintains, and ensures adherence to multiple project schedules

Preferred Knowledge, Skills and Abilities:

  • Ability to effectively interface with clients on the phone and in person
  • Working knowledge of Microsoft Suite of products (Excel, Word, Access)
  • Sound understanding or medical terminology and anatomy.
  • Good understanding of Medicaid required, Medicare and commercial experience a plus.
  • In depth knowledge of coding principals including but not limited to NCCI Edits, CPT, HCPCS and ICD-9 codes and modifiers; and/or MSDRG, Revenue codes, and APCs.
  • In depth knowledge of UB04 and medical (1500) claim formats and requirements.

Minimum Education:

  • High School Diploma or GED required – will be verified

Minimum Related Work Experience: :

  • 1-3 years of healthcare reimbursement experience such as provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing, and/or revenue cycle improvement required.
  • Must have demonstrated experience and knowledge of healthcare claims processing (Medicaid, Medicare, Commercial Insurance), including ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, etc. preferred.
  • Experience in healthcare auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred.
  • Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience a plus preferred

Requirements

 
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Medical Claims Auditor - Irving, TX Apply now