Provider Reimbursement Auditor

Job Summary

A company is looking for a Provider Reimbursement Auditor.

Key Responsibilities

• Conduct quality audits of provider claims to ensure compliance with guidelines
• Analyze errors and determine root causes for corrective actions
• Utilize audit software to document audit observations and validate responses

Required Qualifications

• Associate's degree in a related field or equivalent experience
• 2+ years of experience in medical or pharmacy claims processing or claims pricing
• Familiarity with Medicaid and Medicare reimbursement rules
• Knowledge of CPT/HCPCS Coding preferred
• Proficient in Microsoft Excel and Word