Audit Technician Denied Medical Claims
1 day ago
Key Responsibilities
- Review denied medical claims to determine reasons for denial (coding errors, missing information, medical necessity, eligibility, etc.).
- Collect, organize, and verify supporting documentation needed for appeals or audits.
- Prepare and submit claim audit packets for internal review or external payor reconsideration.
- Collaborate with clinical staff, coders, and billing teams to resolve discrepancies and correct claim data.
- Maintain accurate tracking of denied claims, appeals filed, and outcomes for reporting purposes.
- Identify trends in denials and escalate recurring issues to management for process improvement.
- Ensure compliance with HIPAA, CMS, and payor guidelines.
- Assist with internal audits, quality checks, and special projects as assigned.
Qualifications
- Bachelor's degree in healthcare administration, business, or related field preferred.
- Minimum of 3 years prior experience in medical claims, billing, coding, or auditing highly desirable.
- Knowledge of ICD-10, CPT, and HCPCS coding, as well as medical terminology.
- Familiarity with payor policies, EOBs, and claim adjudication processes.
- Strong organizational skills with attention to detail and accuracy.
- Ability to work with confidential patient and claims information in compliance with HIPAA.
- Proficiency in Microsoft Office Suite and experience with claims management systems (Epic, Facets, Availity, etc. preferred).
Skills & Competencies
- Analytical thinking and problem-solving
- Strong written and verbal communication
- Time management and multitasking
- Collaboration and teamwork
- Process improvement mindset
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