Senior Claims Auditor - Facility Based
Description
Job Description
CSCI is looking for a Senior Claims Auditor with at least 6 years' experience specializing in the assessment of facility-based claims.
Responsibilities
- Conduct assessments of medical claims to ensure compliance with eligibility criteria.
- Performs and supports all audits and assessments through phases of planning, pre-audit, fieldwork, and reporting.
- Researches and develops audit criteria, checklists, and test/assessment strategies.
- Develops findings and recommendations.
- Supports junior personnel with complex audit tasks.
Minimum Requirements
- Bachelor's Degree in Health Information Management, Health Administration, or related field.
- At least one of the following certifications in good standing: Certified Coding Specialist (CCS), Certified Professional Coder - Hospital (CPC-H), or equivalent coding certification required. Certification in Facility-Based Coding (e.g. CPC-H) is preferred.
- Minimum (6) years of proven experience in medical coding, preferably in a facility or hospital setting.
- Expertise in medical claims documentation.
- Ability to determine regulatory and program compliance utilizing strong working knowledge of claims processing standards.
- Knowledge of scope and statistical sampling methodologies.
- Quality assurance and coding risk analysis.
- Excellent written and verbal communication skills.
- Strong analytical and problem-solving skills.
- All candidates must be U.S. Citizens and be able to pass a Federal background investigation.
- Ability to obtain a Position of Public Trust.
Preferred Skills
- Experience with coding audits or compliance reviews.
- Knowledge of specific facility-based coding guidelines and payer requirements.
- Strong organizational and time management skills.
- Capability to work in a team environment, as well as independently.
- Ability to maintain a positive relationship with customers and other vendors.
- Demonstrated ability to comply with data standards and policies.
- Possess motivation to learn new technologies and methodologies that demonstrate value.
About CSCI
CSCI is an award-winning information technology and financial management consulting firm founded on one simple philosophy: “Do what is right, always.” We apply this philosophy across all elements of our growing business, from delivering world-class services for customers to providing an environment for associates that encourages personal and professional growth. At CSCI, work and fun aren’t diametrically opposed. Our goal is to hire people with proven track records and retain them with an energizing, diverse company culture. We value each associate’s natural drive to excel, and we provide them with the freedom to do things their way. CSCI seeks the best and brightest in the industry; those who are ready to move their lives and career forward. Join us today and get excited about Mondays again!
Benefits of Working at CSCI
- Competitive Salaries
- 15 Days Paid Time Off (PTO), plus 11 Paid Holidays
- Full Health Benefits Package including Medical, Dental, and Vision
- 401K Retirement Plan
- Team Building Events and Employee Parties
CSCI is an Equal Opportunity/Affirmative Action Employer
Minorities, females, veterans, individuals with disabilities, sexual orientation, and gender identity. While all candidates are considered, CSCI encourages the above individuals to apply.
CSCI is committed to helping individuals with disabilities to participate in the workforce and ensuring equal opportunity to compete for jobs. If you require an accommodation, please contact CSCI Human Resources for further assistance. For questions regarding the qualifications listed above, please contact the CSCI Talent Acquisition Team.
DISCLAIMER
The above declarations are not intended to be an all-inclusive list of the duties and responsibilities of the job described, nor are they intended to be such a listing of the skills and abilities required to do the job. Rather, they are intended only to describe the general nature of the job
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