Claims Audit Specialist

📋 Description

• Review claims for pre- and post-payment accuracy and aged inventory
• Verify eligibility, config, payment accuracy, and denial appropriateness
• Document audit findings with methodology and discrepancies
• Provide feedback to Oversight & Monitoring Manager on errors and improvements
• Process high-dollar claims exceeding $10k
• Participate in annual claims audits to address deficiencies and prevent fraud
• Back up the Claims team as needed

🎯 Requirements

• Bachelor’s degree in relevant field; experience may substitute
• 5+ years processing, researching, and auditing Medicare/Medicaid claims
• Experience handling disputes, appeals, and recoveries
• Proficient in Microsoft Excel
• Working knowledge of CPT/HCPCS, ICD-10, and relevant regs
• Experience with CMS and Medi-Cal claims
• Strong organizational, analytical, communication, and time management skills

🎁 Benefits

• Medical, dental, vision insurance
• PTO, holidays, and sick time (17d PTO, 12 holidays, 6 sick days)
• 401(k) with match
• Comprehensive benefits package
• Additional benefits