Claims Audit Extern

Thank you for considering Progyny!

Progyny is seeking a Claims Audit Extern to join our team. This role will primarily support claims audits, quality assurance reviews, and other related audit activities.

In this role, you'll gain hands-on experience in healthcare claims auditing while working with provider clinics and cross-functional teams to support coding accuracy, compliance, and continuous improvement.

• Participate in claims audits and quality assurance reviews, including selecting and preparing patient claim samples, evaluating claims and provider documentation, validating CPT/HCPCS and ICD-10-CM coding, modifiers, billing accuracy, and adherence to applicable coding and documentation guidelines.
• Document audit findings and prepare audit reports, including work papers, Executive Summaries/Management Response Forms, and other required audit documentation.
• Provide education to provider clinics and applicable stakeholders regarding audit findings, coding, billing, documentation requirements, and corrective actions.
• Assist with special projects and work cross-functionally with internal departments as needed to support audit initiatives, reporting, data analysis, operational goals, and other assigned responsibilities.

• CPC-A, CPC, CCA, CCS, or CCS-P certification required.
• Strong Microsoft Office skills, particularly Excel, with the ability to work efficiently with large datasets, pivot tables, and structured audit information.
• Working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, coding guidelines, or healthcare claims concepts; familiarity with reimbursement or payer policy research is a plus.
• Excellent written and verbal communication skills with strong attention to detail and the ability to clearly document findings.
• Comfortable working independently in a fast-paced environment while managing multiple priorities and deadlines.
• Demonstrated ability to be adaptive, inquisitive, analytical, and solution-oriented.
• Ability to collaborate effectively with cross-functional stakeholders and communicate professionally with provider clinics and internal leaders.
• Interest in healthcare audit, coding, payment integrity, reimbursement, provider billing, process improvement, or healthcare operations.
• This remote position may require occasional travel for in-person audits, team meetings, or other business needs.

This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.

Progyny (Nasdaq: PGNY) is a global leader in women's health and family building solutions, trusted by the nation's leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians.

Our benefits solution empowers patients with concierge support, coaching, education, and digital tools;provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.

Our mission is toempower healthier, supported journeys through transformative fertility, family building and women's health benefits.

Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME
100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit

• Family friendly benefits:
  Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents' Employee Affiliation Group

• Menopause and midlife care

• Health, dental, vision and life insurance options for employees and family

• Free in-person, virtual and text-based mental health and wellness support

• Paid time off, including vacation, sick leave, personal days and summer flex time

• Company equity

• Bonus program

• 401(k) plan with company match

• Access to on-demand legal and financial advice

• Learning and development programs to help you grow…