Medical Claims Auditor

The CSI Companies - Irving, TX3.7

The CSI Companies is a National professional staffing form. We are seeking a talented individual for a Medical Claims Auditor II to work for one of our healthcare clients in the Irving, TX area!

Duration: Contract to hire

Hours: Monday- Friday, standard business hours

Pay: $28/hour- conversion salary $60-70K

This person will performs research analytics to support our Coordination of Benefits line of business. Assists in the development and implementation of new claim follow up processes for identifying claims that are denied incorrectly.

Essential Responsibilities:
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

Knowledge, Skills and Abilities:
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

Minimum Education:
High school diploma or GED required; Bachelor’s degree preferred
Minimum Related Work Experience: 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.
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.