Medical Claims Auditor

  • Quick Med Claims.com
  • Pleasant Hills, PA, USA
  • Jul 09, 2018
Full time Accounting/Finance/Banking Medical/Health Care

Job Description

Medical Transportation Billing Company seeking to fill an Medical Claims Auditor position.  This is a full-time Monday through Friday daylight opportunity.  The successful candidate will have 2-5 years of Ambulance Billing and Coding experience, as well as an Associates Degree or equivalent experience.  Licensure through the NAAC Ambulance Billing Certification is preferred.  QMC provides a comprehensive benefit package including: medical, dental, vision, 401K, disability and life insurance.  Holidays and paid time off are also provided.

Job Purpose/Summary

Under the direction of the Corporate Compliance Officer, the Medical Claims Auditor will be primarily responsible for continual auditing of trips billed to ensure proper procedures are being followed.  Additionally, this position is responsible for completing documentation to compile results and report the information to the compliance team.

Essential Duties & Responsibilities

  • Reviews and studies all information published by HCFA and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing and reimbursement compliance;
  • Reviews and studies all information from third party payers relative to claims filing, coding, and the adjudication process;
  • Reviews, assesses, studies and analyzes the overall coding, billing, documentation and reimbursement system for potential compliance problems and non-compliant activities;
  • Works with compliance management, patient accounts, information system and other personnel to solve and implement solutions to maintain a proper compliance stance;
  • Works with compliance management to identify problematic areas to develop and implement staff training for improvements of compliance audits;
  • Conducts informal audits on various aspects of the coding, billing, documentation and reimbursement system;
  • Provides training sessions for both general and specific problem resolution in the coding, billing and reimbursement area;
  • Attends workshops and seminars to maintain a high level of knowledge and capabilities;
  • Monitors overall compliance in the coding, billing, documentation and reimbursement area;
  • Reviews redeterminations and reconsiderations for potential errors; and
  • Addresses special projects and other related duties as assigned.

Minimum Qualifications

Education

  • Associates degree or equivalent preferred; and
  • CAC Certification preferred.

Experience      

  • Two to five years of emergency, non-emergency, and air billing

Knowledge, Skills, Abilities    

  • Proficient computer skills, including working knowledge of Microsoft Word, Excel, and Outlook;

  • Time management skills, with the ability to multitask;

  • Exemplery customer service skills;

  • Organizational skills;

  • Sufficient written and oral communication skills;

  • Ability to work in a fast-paced environment;

  • Clear understanding of Medicare ambulance billing guidelines; and

  • Clear understanding of Medicare claims processing guidelines