CLAIMS AUDITOR I LOCATION

Doral, FL 33178 TYPE On-site

TYPE OF CONTRACT

Temp to Perm

PAY RATE

$23.00 - $26.00 per hour

DESCRIPTION

We are seeking a detail-oriented Claims Auditor I to perform pre- and post-payment audits within a managed care healthcare environment. This role ensures claims accuracy, regulatory compliance, and adherence to CMS Medicare guidelines while identifying discrepancies and opportunities for process improvement.

Key responsibilities include:

Perform pre- and post-payment audits, including high-dollar and complex Medicare claims. Review underpayment disputes and claims examiner work for accuracy and compliance. Validate eligibility, coding (CPT, HCPCS, ICD), pricing, reimbursement, authorizations, and medical necessity. Interpret CMS requirements, medical policies, and reimbursement guidelines. Document audit findings, discrepancies, financial impact, and processing or system errors. Track audit trends, identify root causes, and recommend corrective actions and process improvements. Provide feedback to claims teams and collaborate with internal departments to resolve complex issues. Identify potential overpayment and recovery opportunities. Maintain required audit volumes and turnaround times.

REQUIREMENTS

High School Diploma or GED required. Minimum 5 years of claims processing experience , preferably in healthcare or insurance. At least 1 year of quality audit or claims auditing experience . Medicare/CMS and managed care experience strongly preferred. Knowledge of medical terminology, claims systems, CPT, HCPCS, and ICD-10 coding. Understanding of claims adjudication, reimbursement methodologies, and audit practices. Strong analytical, research, problem-solving, and attention-to-detail skills. Ability to work independently, manage priorities, and meet deadlines. Effective written and verbal communication skills. Experience with underpayment disputes or payment integrity functions preferred. Equivalent combinations of education and experience may be considered. At ttg, "We believe in making a difference One Person at a Time," ttg OPT. IND3