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1 result for It Auditor in Santa Rosa, CA
- Emeryville, CA
- remote
- Temporary
- 39.5865 - 45.837 USD / Hourly
- <p>We are looking for an experienced Medical Claims Auditor to join our team in Emeryville, California. In this long-term contract position, you will play a pivotal role in ensuring the accuracy and compliance of medical claims while also serving as a trainer to enhance team knowledge and performance. If you have a strong background in medical coding, auditing, and training, this opportunity is ideal for you.</p><p><br></p><p>Responsibilities:</p><p>• Conduct detailed audits of paid, pending, and denied medical claims to ensure proper coding, adherence to benefit rules, and compliance with state and federal regulations, including the California Knox-Keene Act and Medi-Cal.</p><p>• Design and deliver comprehensive training programs for Claims Examiners, focusing on workflows, updated policies, and emerging technologies.</p><p>• Investigate complex claim issues, including provider disputes and appeals, and identify trends to propose effective corrective actions.</p><p>• Compile and maintain detailed statistical and quality reports, presenting audit findings and staff performance metrics to management.</p><p>• Stay informed about federal and state billing laws, including Medicare guidelines, to ensure compliance during health plan audits.</p><p>• Collaborate with team members to resolve discrepancies and implement efficient claims processing practices.</p><p>• Assist in the development of new audit procedures and quality control measures to continuously improve operations.</p><p>• Provide subject matter expertise in medical coding standards, including ICD-10 and CPT codes, to support organizational goals.</p><p>• Contribute to special projects and initiatives as needed to enhance claims auditing and training functions.</p><p><br></p><p>If you are interested in this role please apply Now for immediate consideration. </p>
- 2026-03-24T00:00:00Z