Medical Claims Auditor

Ultimate Staffing Services is actively seeking a detail-oriented and experienced Medical Claims Auditor to join their client's team in Tennessee. This role is crucial in ensuring the accuracy of healthcare claims and reducing out-of-pocket costs for members. The ideal candidate will have a strong background in medical billing, coding, and claims administration.

Responsibilities:

• Review patient medical bills, correspondence, and Explanation of Benefits (EOBs) for errors.
• Liaise with insurance carriers and providers to address identified issues such as appealing incorrectly denied claims and rectifying billing errors.
• Communicate with providers and carriers via phone and email to ensure prompt and professional responses.
• Identify problems and inconsistencies using management reports and critical thinking skills.
• Utilize expertise to resolve claims and billing issues.
• Review EOBs and examine claims for appropriate coding of CPT and ICD-9 and -10 codes and modifiers against charges that are billed.
• Apply appropriate processes and procedures for medical claims.
• Review and apply member benefit plans and provider contracts to ensure proper benefits and contract language is applied to each claim.

Requirements:

• Background in medical billing or insurance claims administration is strongly preferred.
• 3-5+ years of experience in Medical Billing and Coding.
• Strong critical thinking and problem-solving skills.
• Proficiency in Explanation of Benefits (EOB) knowledge.
• Strong interpersonal skills and self-motivated.
• Experience with Out of Network (OON) Benefits is advantageous.
• Understanding of general Coordination of Benefit Rules and Benefit Analysis.
• Experience in overturning claim denials and collaborating with external stakeholders.
• Excellent time-management and multitasking skills.
• Knowledge of CPT/ICD-9 and -10 required; Medical Billing and/or Coding Certificate a plus.
• Proficiency with Microsoft Office Suite (Outlook, Word, Excel etc.).

Work Hours:

Monday to Friday, 1st shift

Benefits:

The role offers a competitive pay range of $20 to $24 per hour.

If you are passionate about the healthcare industry and have the necessary skills and experience, please apply directly to this job posting for consideration.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.