Medical Claims Auditor

  • Quick Med
  • Pleasant Hills, PA, United States
  • Dec 18, 2017
Full time Medical/Health Care

Job Description

 Job Purpose/Summary

Under the direction of the Corporate Compliance Officer, the Audit Specialist 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.

Minimum Qualifications 


  • Associates degree or equivalent outside work experience


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

Licenses, Certifications & Clearances

  • Ambulance Billing Certification from (PWW)

Knowledge, Skills, Abilities

  • Proficient computer skills
  • Customer service oriented
  • Time management and the ability to multitask are essential
  • Organizational skills
  • Must display sufficient written and oral communication skills
  • Must have the ability to work in a fast paced environment
  • Must have a clear understanding of Medicare ambulance billing guidelines
  • Must have a clear understanding of Medicare claims processing guidelines
  • Must have a Zero Audit error rating for a minimum of 3 months


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.
  • Addresses special projects as assigned.