Medical Claims Auditor (Remote) in Texas

Medical Claims Auditor (Remote) - Talento - Texas - work from home job Company: Talento Job description: Medical Claims Auditor (Remote) TalentoHCM is partnered with a $1b+ revenue organization with 10,000+ employees that provides public sector technology and back-office solutions enabling $800b+ in healthcare spend. They are looking to add a remote medical claims auditor to their organization for a long-term assignment. Responsibilities • Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements. • Applies knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new overpayment recovery opportunities. • Works with data miners, clinical staff, and stakeholders to identify new overpayment issues for each client. • Tracks, and follows-up on results and recoveries • Contributes new ideas for improving existing audit processes and audit queries. Works cohesively with the audit team. • Develops, maintains, and ensures adherence to multiple project schedules Experience • Strong Conceptual and analytical skills • Strong Project management skills • Ability to develop, organize, and maintain project plans and agendas • Ability to effectively interface with clients on the phone and in person • Working knowledge of bolthires Suite of products (Excel, Word, Access) • Sound understanding or medical terminology and anatomy. • Good understanding of Medicaid required, Medicare and commercial experience a plus. • In depth knowledge of coding principals including but not limited to NCCI Edits, CPT, HCPCS and ICD-9 codes and modifiers; and/or MSDRG, Revenue codes, and APCs. • In depth knowledge of UB04 and medical (1500) claim formats and requirements. Work Conditions and Physical Demands • 1-3 years of experience in medical claims or medical billing and coding. Pay Rate Range: $15.00 per hour Talento Human Capital Management is an equal opportunity employer people are at the center of what we do! Our organization continues to thrive through our ongoing commitment to building an inclusive and diverse workforce from different backgrounds and perspectives. People + Passion + Perseverance = Progress. About Talento: Talento Human Capital Management provides talent and organizational solutions enabling businesses to evolve beyond tactical human resources management. Our footprint spans across the US Latin America and Asia. Expected salary: $15 per hour Location: Texas Job date: Thu, 21 Sep 2023 03:43:07 GMT Apply for the job now! Apply tot his job Apply tot his job Apply tot his job