Quality Assurance Auditor

Description

THIS IS NOT A REMOTE OPPORTUNITY. QUALIFIED CANDIDATES MUST BE ABLE AND WILLING TO COMMUTE TO THE AMARILLO, TX OFFICE.

The Claims Auditor is responsible for the investigation of both registered and processed claims. Responsible for reviewing and making both payment and procedural determinations. This position will conduct root cause analysis and detail review of group health plan documents and IMS claims registration and claims paying procedures.

ESSENTIAL FUNCTIONS OF THE ROLE

• Review procedures, data entry, paid claims, and plan documents to provide quality assurance documentation.
• Stay up to date on internal procedures.
• Performs other position appropriate duties as required in a competent, professional and courteous manner.

Qualifications

• Medical Terminology, Anatomy and Physiology knowledge.
• Protect Data integrity and validity.
• Abide by patient confidentially (HIPAA) regulations and guidelines for accessing and disclosure of protected health information.
• Demonstrates knowledge of Correct Coding Principals of CPT, ICD-10, and HCPCS.
• Ability to communicate effectively.
• Ability to work independently and with minimal amount of supervision.
• Proficient in the use of Microsoft Office Suite (with emphasis on Outlook and Excel).