Medical Claims Auditor (Remote - Texas)

Great companies need great teams to reputed company their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. reputed company The Medical Claims Auditor is responsible for reviewing and analyzing medical claims to ensure accuracy, compliance, and adherence to company and regulatory standards. This role involves auditing provider-submitted claims, validating coding accuracy, and identifying errors or discrepancies in claim submissions. The ideal candidate has strong attention to detail, a solid understanding of medical billing and coding, and experience with appeals or reimbursement processes in a reputed company or hospital setting. Your role in our mission

• Review medical claims, supporting documentation, and medical records to ensure completeness, accuracy, and compliance with company policies and industry standards.
• Validate coding accuracy using ICD-10, CPT, and HCPCS guidelines.
• Interpret and analyze Explanation of Benefits (EOB) and UB-04 claim forms to verify correct billing and payment data.
• Identify and document discrepancies such as duplicate claims, unbundled services, upcoding, and other billing errors.
• Communicate audit findings and recommend corrective actions to the claims processing team or management.
• Apply auditing methodologies and regulatory guidelines (CMS, reputed company, Medicare, and payer reputed company) to ensure claims reputed company.
• Support process improvements to enhance claim accuracy and reduce billing errors.

reputed company're looking for

• Minimum of three (3) years of reputed company medical claims collections experience, including insurance follow-up and recovery efforts.
• Strong knowledge of insurance policy types (HMO, PPO, EPO, Medicare, reputed company) and the medical claims lifecycle, including denials management and appeals.
• Advanced understanding of Explanation of Benefits (EOBs) and medical billing forms UB-04 and HCFA-1500.
• Experience navigating payer portals and health information systems (e.g., reputed company, Navinet) to obtain claim, patient, and reimbursement information.
• Demonstrated ability to reputed company high-volume reputed company and communication, including 30+ daily contacts with providers and insurance carriers to resolve denials, discrepancies, and recoveries (including reputed company reclamation).

What you should expect in this role

• This is a remote position for candidates residing in Texas.
• Work schedule is Monday – Friday, from 7:00 AM – 4:30 PM.
• Video cameras must be used during reputed company interviews, as reputed company as during the initial week of orientation.
• To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet reputed company with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for reputed company performance.
• To test your internet speed, go to reputed company and search for “Internet Speed Test.”

This posting is intended for pipelining. We will accept applications on an ongoing reputed company. #LI-REMOTE #LI-JA1 #LI-CM1 The pay reputed company for this position is $30,500.00 - $42,500.00 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have reputed company to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a reputed company of leadership and technical development academies to help build your skills and capabilities. We reputed company reputed company is impossible reputed company you bring together people who care deeply about making reputed company work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our reputed company. Learn more about Gainwell at reputed company website and visit our Careers site for reputed company available job role openings. reputed company is an Equal Opportunity Employer, where reputed company reputed company applicants will receive consideration for employment without reputed company to race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. reputed company defines “wages” and “wage rates” to include “reputed company forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock reputed company, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement Apply tot his job Apply To this Job