The CSI Companies is currently seeking a Medical Claims Auditor to support one of our clients in the Las Vegas area.
The CSI Companies understands that an attractive benefits package is important for recruiting above-average candidates. While on contract, we offer a benefits package that includes weekly pay, direct deposit, multiple healthcare plans (Vision, Dental, Disability options, Holiday Pay, & Paid Time Off) if eligible.
Main Job Duties:
• Participates in the review of health insurance claims and member eligibility information to perform root cause analysis on misapplication of payment policies, medical policies, billing guidelines, and applicable regulatory requirements.
• Tracks, and follows-up on results and recoveries
• Contributes new ideas for improving existing processes. Works cohesively with IT, operations, carriers, and clients.
• Develops, maintains, and ensures adherence to multiple project schedules
• 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.
• High school diploma or GED required; Bachelor’s degree preferred
• 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
• Strong Conceptual and analytical skills
• In depth knowledge of UB04 (institutional) and medical 1500 (professional) claim formats and requirements.
• In depth knowledge of coding principals including but not limited to NCCI Edits, CPT, HCPCS and ICD-9 codes and modifiers, and revenue codes
• Good understanding of Medicaid required, Medicare and commercial experience a plus.
• Sound understanding of medical terminology and anatomy.
• Ability to develop, organize, and maintain project plans and agendas
• Working knowledge of Microsoft Suite of products (Excel, Word, Access)
• Strong Project management skills