Healthcare Claims Auditor

  • location: Franklin, TN
  • type: Permanent
  • salary: $20 - $24 per year
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job description

Healthcare Claims Auditor

job summary:

Contract-to-Hire $50,000 to 53,500

Leading Healthcare Data Analytics company is looking for multiple Auditor's to join their Data Mining team. The primary role of the Claims Auditor is to review, identify, and validate claim overpayments.

Types of overpayment reviews will include, but are not limited to: Duplicate Payments, Contract Compliance, Eligibility, and Coordination of Benefits (COB).

Team: Commercial Data Mining total employees are 200+; position will be part of a client team varying in size due to the assigned client. 2-4, 4-6, 6-8, are most team sizes.

location: Franklin, Tennessee
job type: Permanent
salary: $20 - 24 per year
work hours: 9am to 5pm
education: Bachelors
  • Review all review of post-paid claims on behalf of the Payer

    • Duplicate Payments, Contract Compliance, Eligibility, and Coordination of Benefits.
  • Learn and fully understand client systems, trending and test file processes, and the current production inventory portfolio
  • Identify training opportunities within existing production cases
  • Create and complete lead tickets and test files for client
  • Review top denial reasons for training opportunities, potential rebuttals back to the client, and query enhancement
  • GPA of 3.0 and above from an Accredited College or University
  • Strong organizational skills and an eye for attention to details
  • Backgrounds in Risk, Auditing, Underwriting, Supply Chain Management, or Healthcare are highly preferred
  • Above average math skills and the ability to learn proprietary software
  • Prior Healthcare (Payer Side) or Insurance Experience Preferred
  • Ability to read/understand basic SQL Preferred
skills: Benefits Upon Conversion

  • Medical, Dental, and Vision
  • 401K Matching and Stock Purchase Plan Option
  • Quarterly Bonus Potential
  • 2 Weeks Accrued PTO
  • Flex Hours

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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