Clinical Claims Auditor

1 week ago


Columbus, Ohio, United States inAssist Full time
About the Position

We are seeking a skilled Medical Billing Specialist to join our team at inAssist Healthcare Management Solutions.

This role involves reviewing complex healthcare claims, identifying discrepancies, and verifying pricing to reduce members' out-of-pocket healthcare costs.

The ideal candidate will have strong critical thinking and problem-solving skills, proficiency in EOB knowledge, and experience with medical billing and coding.

Key Responsibilities:

  • Review patient medical bills, correspondence, and Explanation of Benefits (EOBs) for errors.
  • Liaise with insurance carriers and providers to address identified issues.
  • Communicate with providers and carriers via phone and email to ensure prompt and professional responses.
  • Identify problems and inconsistencies using management reports and critical thinking skills.
  • Utilize expertise and take initiative to resolve claims/billing issues.
  • Apply appropriate processes and procedures for medical claims.
  • Review and apply member benefit plans and provider contracts to ensure proper benefits and contract language is applied to each claim.

Requirements:

  • Background in medical billing or insurance claims administration.
  • 3-5+ years' experience in Medical Billing and Coding.
  • Strong critical thinking and problem-solving skills.
  • Proficiency in EOB knowledge.
  • Strong interpersonal skills.
  • Self-motivated and reliable.
  • Proven exceptional ability to organize, prioritize, and communicate effectively with carriers and providers.
  • Experience with Out of Network (OON) Benefits is advantageous.
  • Understanding of general Coordination of Benefit Rules, Benefit Analysis.
  • Knowledge of eligibility requirements and insurance enrollment.
  • Experience in overturning claim denials.

Salary Estimate: $65,000 - $85,000 per year based on location and experience.



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