Medical Claims Auditor
7 days ago
About Us
Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region.
As a Medical Claims Auditor, you will be responsible for auditing behavioral and medical claims and ensuring quality metrics are met by conducting post-claims reviews on posted claims for Texas Medicaid and CHIP programs.
The estimated salary for this position is $60,000 - $80,000 per year, depending on experience.
Job Description:
We are seeking a skilled auditor to join our team. As a Medical Claims Auditor, you will be responsible for:
- Auditing behavioral and medical claims for quality and accuracy
- Conducting post-claims reviews on posted claims for Texas Medicaid and CHIP programs
- Ensuring claims payment integrity aligns with regulatory standards, timelines, business policy, provider and HHSC contracts
- Communicating audit results to the Reimbursement and Analysis Manager in a structured report format within required timelines
Required Skills and Qualifications:
To be successful in this role, you will need:
- An associates degree or a minimum of 5 years of claims/audit experience
- Strong organizational skills, problem-solving and decision-making skills
- Advanced knowledge of claim adjudication and benefit plan application for Medicaid and CHIP programs
- Microsoft Office skills including Word, Excel and Access
Benefits:
We offer a competitive salary and benefits package, including health insurance, retirement savings plan, and paid time off.
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