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Job Title:

Claims Auditor (Remote - WI or MN)

Cost Center:

682891379 SHP-Claims

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

Mon-Fri; day shifts (United States of America)

Job Description:

JOB SUMMARY

The Claims Auditor is responsible for performing payment, procedural accuracy, turnaround time, compliance and operational audits as directed by management. The Claims Auditor has working knowledge of the overall aspects of claim processing, both in and outside of Security Health Plan. Audit responsibilities include applying effective, appropriate and efficient audit procedures in collecting, analyzing and reporting concise and relevant findings.

JOB QUALIFICATIONS

EDUCATION

_For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation._

**Minimum Required:** High school diploma or equivalent. Successful completion of the following courses per departmental procedures, within one year of hire: current procedural terminology (CPT), current international classification of diseases (ICD), health care procedure coding system (HCPCS) and medical terminology.

**Preferred/Optional:** Associate degree in business, medical or related field. Successful completion of the following courses per departmental procedures at time of hire: current procedural terminology (CPT), current international classification of diseases (ICD), health care procedure coding system (HCPCS) and medical terminology.

EXPERIENCE

**Minimum Required:** Three years’ experience related to health insurance claim processing. Three years’ experience related to CPT/HCPCS and current ICD coding. Demonstrated proficiency with analytical problem solving, written and oral communications and the Microsoft Office Suite. Working knowledge of anatomy & physiology.

**Preferred/Optional:** One year experience in claims auditing.

CERTIFICATIONS/LICENSES

_The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position._

**Minimum Required:** Certified Professional Coder (CPC) or Certified Professional Coder – Payer (CPC-P) certification awarded by the American Academy of Professional Coders (AAPC) within three years of hire based on the department position the resides in.

**Preferred/Optional:** Certified Professional Coder (CPC) or Certified Professional Coder – Payer (CPC-P) certification awarded by the American Academy of Professional Coders (AAPC) at time of hire.

QUALIFYING APPLICANTS FROM WI & MN WILL BE CONSIDERED

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program** **.

Marshfield Clinic Health System is an Equal** **Opportunity/Affirmative** **Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.