About this role
Role Overview
- Conduct post-audit reviews of healthcare claims to ensure accuracy and compliance with payer policies, regulations, and billing guidelines.
- Verify that claims are billed correctly, including checking codes, modifiers, and the application of benefits.
- Identify and analyze discrepancies or errors in claims processing.
- Work with claims processors and providers to resolve issues or discrepancies.
- Prepare and document findings and recommendations for corrections.
- Generate detailed reports on audit findings, including error trends, compliance issues, and recommendations for process improvements.
- Maintain accurate records of audits, findings, and resolutions.
- Analyze audit results to identify areas for process improvement within the claims processing system.
- Collaborate with internal teams to implement changes and improve claim accuracy and efficiency.
- Communicate with healthcare providers and payers regarding audit findings, discrepancies, and required corrections.
Requirements
- Bachelor Degree in relevant field with 2
- 4 years of relevant experience
- Ensure that claims processing adheres to federal, state, and payer-specific regulations.
- Stay updated on changes in healthcare regulations and payer policies to ensure compliance.