Claims Auditor

About the role

We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification.

What you'll do

• Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement
• Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement
• Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications
• Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews
• Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits

What you need

• 3–5 yrs of experience
• Medical coding
• Audit
• Compliance
• Any graduate