Claims Quality Auditor jobs in Maryland

Baltimore-based Medicaid Managed Care Organization company is seeking a hardworking and reliable individual for Claims Auditor position. The Claims Auditor will review and analyze claims data, professional and institutional medical claims, medical records, and billing and payment information to determine if charges and reimbursement are supported in accordance with federal, state, and corporate guidelines.

Claims Auditor Responsibilities will include:

• Perform documentation and coding audits, reviewing medical claims, records, and charges to ensure compliance with CPT coding and ICD10 coding standards.
• Conduct analysis of findings to identify trends/problems in billing and documentation.
• Draft written reports that detail audit findings and recommendations to senior leadership, Department management/personnel, and/or other related business partners.
• Analyze current payment policies and make recommendations to improve program integrity and organizational processes.
• Perform additional duties as assigned.

Claims Auditor Requirements include:

• Bachelor’s degree
• Five years of related experience with medical claims, reviews such as utilization management, quality assurance, charge capture, coding, billing and medical necessity to facilitate correct claims submission to federal and state payers is preferred.
• Proficient knowledge of Medicaid, Medicare and national claim submission requirements pertaining to documentation, coding, billing, and reimbursement.
• Excellent verbal and written communication skills.
• Able to work well independently and maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Physical setting:

• Office

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Bachelor's (Required)

Experience:

• claims: 3 years (Required)

Work Location: In person