Remote Medical Claims Auditor

Overview

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, aiming to make healthcare affordable and improve patient health.

In Short

• Understand and stay current with client contract criteria and requirements.
• Ensure accuracy of claims processing through internal audit processes.
• Perform targeted audits of claims processing, including high dollar payments and multiple procedure claims.
• Conduct quality audits of claims and eligibility staff.
• Audit new client setups in claims processing software.
• Run access queries for administrative purposes.
• Other duties as assigned.

Requirements

• Minimum 3 years of experience in healthcare or managed care industry.
• 1-3 years auditing experience in the healthcare industry.
• Advanced proficiency in Microsoft Office products.
• Able to problem solve and make decisions.
• Thorough understanding of healthcare compliance requirements.
• Ability to meet deadlines and analyze data.
• Organized, self-motivated, and detail-oriented.
• Effective communication skills.

Benefits

• Fully remote work environment.
• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan with employer match.
• Life and Disability insurance.
• Flexible Time Off.
• Paid parental leave.
• Resources for professional growth and development.