Payment Integrity Auditor I
About the positionResponsibilities• Conduct entry-level audits of professional and facility claims to ensure coding accuracy and compliance with contractual, coding, payment policy, and regulatory standards. • Review itemized bills, medical records, and other claim documentation to verify coding accuracy and appropriateness of charges. • Validate coding accuracy for CPT, HCPCS, ICD-10-CM, and DRG. • Identify and report coding discrepancies or errors and recommend adjustments where appropriate. • Identify opportunities for fraud, waste, and abuse prevention and control.• Maintain accurate and detailed records of audit findings and outcomes for reporting purposes. • Collaborate with internal teams (e.g., claims processing, provider relations, special investigations unit). • Utilize auditing software and systems to document, track, and analyze claims data. • Stay updated on coding guidelines, payer policies, and industry standards, including CMS regulations. • Participate in ongoing training and development to enhance coding and auditing skills. • Support Payment Integrity team initiatives by contributing to process improvement efforts and team goals.Requirements• Bachelor's Degree or equivalent combination of education and experience. • 1 year of related medical coding or auditing experience. • CertifiedProfessional Coder Designation (CPC-A, CPC, CSS, CPMA) or equivalent. Nice-to-haves• Knowledge of health plan operations and claim adjudication processes. • Experience with facility, professional, and ancillary coding. • Familiarity with auditing software tools. Benefits• Medical, vision, and dental coverage with low employee premiums. • Voluntary benefit offerings, including pet insurance for paw parents.• Life and disability insurance. • Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service. • Wellness incentives with a wide range of mental well-being resources for you and your dependents. • Generous paid time off to reenergize. • Tuition assistance for both undergraduate and graduate degrees. • Employee recognition program to celebrate anniversaries, team accomplishments, and more. • On-campus model provides flexibility with access to on-site resources, networking opportunities, and team engagement.• Commuter perks and free convenient on-site parking. • Subsidized on-campus cafes. • Engaging on-site activities such as health and wellness events. • Complementary fitness & well-being center offering in-person and virtual workouts and nutritional counseling. Apply tot his job