Premium Auditor examining financial records for compliance in insurance industry. Conducting audits, preparing reports, and traveling to various locations within assigned territory.
Responsibilities
- Examines claims for compliance with relevant billing and processing guidelines
- Identifies opportunities for fraud and abuse prevention and control
- Reviews and conducts analysis of claims and medical records prior to payment
- Uses required systems/tools to accurately document determinations
- Researches new healthcare related questions as necessary to aid in investigations
- Stays abreast of current medical coding and billing issues, trends and changes in laws/regulations
- Collaborates with the Special Investigation Unit and other internal areas
- Recommends possible interventions for loss control and risk avoidance
- Assists with training of new associates
Requirements
- Requires a AA/AS
- Minimum of 3 years medical coding/auditing experience
- Minimum of 1 year in fraud, waste abuse experience
- Requires coding certification (CPC, CCS, CPMA)
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology (strongly preferred)
- Bachelor's degree (strongly preferred)
- Medical coding and auditing experience (strongly preferred)
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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