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Medical Claims Auditor

Description

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


Requirements:

• 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

Requirements

 

Job Snapshot

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

Description

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


Requirements:

• 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

Requirements

 
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