Medical Claims Auditor

Medical Audit Specialist Main Responsibilities: Billing and Payment Review Audits: Conduct thorough examinations of billing practices to ensure accuracy, compliance with policy terms, coding standards, and regulatory requirements.Collaborate with healthcare providers to clarify billing practices, ensure compliance, and streamline audit processes.Identify areas for improvement in the healthcare system by analyzing data and collaborating with stakeholders.Analyze complex claims data, identify discrepancies or irregularities, and implement process improvements.Work Experience Requirements: A minimum of 3 years of experience in medical claims auditing, payment integrity, healthcare compliance, or a similar role within the insurance or healthcare industry.Licensure / Certification Requirements: Coding or auditing certifications are highly desired.Licensed clinicians also possess advantageous qualifications.Education: A Bachelor's degree in Medicine, Healthcare Administration, Business, or a related field is required.Skills & Competencies: Strong knowledge of healthcare regulations, ethical standards, and auditing best practices.Proficiency in healthcare billing and coding practices, understanding of claims processing systems, and familiarity with medical terminology.Excellent analytical skills, ability to interpret complex claims data, and identify discrepancies or irregularities.Effective communication, collaboration, and negotiation skills to interact with diverse stakeholders.A proven track record in developing and implementing policies, conducting audits, and driving process improvements.Maintain confidentiality and provide high-quality work while ensuring results-oriented outcomes.Good knowledge of Microsoft applications.