Provider Reimbursement Auditor
$48,318–$82,389 year
RemoteCalifornia, United States or Texas, United States
Job Summary
Perform comprehensive audits of provider claims against source documents to identify mis-payments and analyze errors for root cause determination. Utilize audit software to provide written documentation regarding observations and review responses to validate accuracy. Maintain state ACME, review state websites for updates, document business decisions, and identify required updates for department pricing tools. Requires 2+ years of claims processing experience, strong Excel skills, and knowledge of Medicaid/Medicare reimbursement rules. Pay range $23.23 - $39.61 per hour with remote, hybrid, or office work schedules available.
Required Qualifications
- Associate's degree in related field or equivalent experience
- 2+ years of medical or pharmacy claims processing or claims pricing experience
Desired Qualifications
- Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts preferred
- Knowledge of CPT/HCPCS Coding preferred
- Strong Excel Skills
- Excel Calculator
- Experience working remote
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