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Medical Coding Auditor I

2 hours, 59 minutes ago
United States
Full-time
Junior
QA Engineer
Quality Assurance and Testing
Apply Now
Healthcare Management Administrators

Healthcare Management Administrators

Healthcare Management Administrators is a specialized third-party administrator that provides high-quality, innovative, and affordable health plans for self-funded employers, emphasizing exceptional service and a collaborative partnership model.

Insurance
251-1K
Founded 1986
View All Jobs 3

Description

  • Conduct detailed audits of medical claims and itemized bills to ensure accuracy and compliance with coding standards such as ICD-10, CPT, and HCPCS.
  • Identify and document billing errors, upcoding, unbundling, and other discrepancies.
  • Review high-dollar claims and complex cases for potential overcharges or inappropriate billing.
  • Validate diagnosis and procedure codes against medical documentation.
  • Ensure coding aligns with payer policies, CMS guidelines, and industry best practices.
  • Support cost containment efforts by identifying opportunities for claim reductions or denials.
  • Assist in developing audit strategies to target high-risk claims.
  • Stay current with changes in coding regulations, payer guidelines, and healthcare laws.
  • Participate in internal quality assurance programs to maintain audit consistency and accuracy.
  • Provide feedback and training to internal teams on coding and billing best practices.

Requirements

  • High school diploma is required.
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification is required.
  • 1-3 years of health plan experience.
  • 1+ years of experience in medical claims auditing, coding, or billing.
  • Familiarity with payer policies, CMS regulations, and medical necessity guidelines.
  • Excellent analytical, organizational, and communication skills.
  • Proficiency with claims systems, EMRs, and Microsoft Office Suite.
  • Strong problem-solving and critical thinking skills.
  • Ability to work independently as a motivated self-starter.
  • Ability to thrive in a deadline-oriented environment and prioritize effectively.

Benefits

  • Base salary of $29.80/hr to $35.57/hr for level I in the greater Seattle area, with level II considered for highly qualified candidates.
  • 17 days of paid time off for individual contributors, plus 11 paid holidays, 2 paid personal days, and 1 paid volunteer day.
  • Company-subsidized medical, dental, vision, and prescription insurance.
  • Company-paid disability, life, and AD&D insurance, plus voluntary insurance options.
  • 401(k) retirement plan with company match.
  • Annual $500 wellness incentive and $600 wellness reimbursement.
  • Remote work options and continuing education reimbursements.
  • Parental leave and up to $1,000 annual charitable giving match.
  • Free parking, gym access, refreshments, and regular in-person team events at the renovated office near Seattle.

Interested in this position?

Apply directly on the company website

Apply Now

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