Baltimore-based Medicaid Managed Care Organization is seeking a hardworking and reliable individual for Claims and TPL Recoveries Auditor position. The Claims and TPL Recoveries Auditor will review and analyze claims data, medical records, and billing and payment information to determine if Third Party Liability (TPL) and/or Coordination of Benefits (COB) opportunities exist and ensure claims reimbursement is supported in accordance with federal, state, and corporate guidelines. Claims and TPL Recoveries Auditor Responsibilities will include: Perform documentation and coding audits, review medical claims, records, and charges to ensure compliance with CPT coding and ICD10 coding standards. Execute appropriate recovery efforts with professional (physician) and institutional (hospital) billing entities. Perform and submit TPL and COB reporting. Identify opportunities for TPL and COB recoveries. Conduct analysis of findings to identify trends/problems in billing and documentation. Draft written reports that detail audit findings and recommendations to senior leadership, Department management/personnel, and/or other related business partners. Analyze current payment policies and make recommendations to improve program integrity and organizational processes. Perform additional duties as assigned. Claims and TPL Recoveries Auditor Requirements include: Bachelor's degree (or equivalent combination of education and experience) Proficient knowledge of Medicaid, Medicare and national claim submission requirements pertaining to documentation, coding, billing, and reimbursement. Excellent verbal and written communication skills. Able to work well independently and maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Final compensation based on qualifications, education, and experience.

Job Type:

Full-time Pay:

$65,000.00 - $110,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Life insurance On-site gym Paid time off Retirement plan Vision insurance

Education:

Bachelor's (Preferred) Ability to

Commute:

Cockeysville, MD 21030 (Required)

Work Location:

In person