Claims Auditor

Claims Auditor (Miami, FL)
Pay: $23 to $26/hour
Type:
Contract

Schedule:

Onsite

• 5+ years of claims processing experience, preferably in healthcare or insurance
• 1+ years in a quality audit or claims auditing role
• Experience with Medicare (CMS) guidelines and managed care environments strongly preferred
• Strong knowledge of CPT, HCPCS, and ICD
  10 coding
• High School Diploma or GED required

Main focus:
This role audits claims processed by claim examiners, including high dollar and complex claims across Medicare managed care lines of business. You'll validate payment accuracy on eligibility, coding, pricing, authorization, and medical necessity against CMS guidelines, document findings, and produce reports used for financial reconciliation and trend analysis. You'll also give feedback to examiners to help drive quality improvement and act as a go to resource on claims auditing standards and Medicare requirements.

• Weekly Pay
• After 30 days:
  Health, Dental, Vision, GAP, Short Term Disability, Accident, Critical Illness and Life Insurance
• Holiday Pay:
  New Year's Day, Memorial Day, 4th of July, Labor Day, Thanksgiving and Christmas
• Milestone Bonus of 40 hours for every 2,000 hours