ClaimDOC is looking for an RN-Medical Claim Auditor. We are a rapidly growing company in downtown Des Moines striving to change the way health care works for the better. We are seeking individuals who are innovative and motivated to join our team and mission!

In this position, you will be responsible for reviewing, auditing, and repricing medical facility and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. Candidate must possess a strong understanding of Medicare guidelines as described below. Must display a high degree of independent judgment and professional skepticism that enhances the work performed in order to achieve success in this position.

What You’ll Be Doing:

  • Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.)
  • Responsible for adjudicating claims to maintain/comply with client contracts and plan documentation
  • Determine accurate payment criteria for clearing pending claims based on defined policy and procedures
  • Work high volume of repetitive claims
  • Identify claim(s) with inaccurate data or claims that require review by appropriate team members
  • Maintain productivity goals, quality standards and aging timeframes
  • Contribute positively as a team player
  • Complete special projects as assigned
  • Comply with all departmental and company policy and procedures
  • Research unclear and unusual claims

Experience You’ll Need:

  • Coding certification required or in process
  • Experience in health plan operations and an understanding of insurance claims processing desired
  • Insurance claims or managed care environment preferred
  • An understanding of provider reimbursement practices including capitation, sub-capitation, case rates, global rates, per diems, percentage discounts, usual and customary fee schedules, RVU and RBRVS-based fee schedules, purchased repriced network, and health plan specific schedules
  • Ability to work in a team environment
  • Integrity and discretion to maintain confidentiality of members, employee and physician data
  • Knowledge of medical billing and coding
  • Knowledge of health insurance, HMO and managed care principles
  • Critical thinking skills and ability to discover and outline systems related issues independently and within a team to provide resolution to work problems
  • Attention to detail
  • Excellent interpersonal, oral and written communication skills
  • Strong attention to detail and organization
  • Able to work independently; strong analytic skills
  • Flexibility in a fast-paced environment

Requirements

  • Current unrestricted state RN license is required
  • Coding Certification (or in process)—CPC, CIC, COC, CPMA
  • Experience equivalent of 5+ years in an auditing or billing role that requires vast knowledge of medical coding and/or Medicare Guidelines in the inpatient, outpatient, or physician setting

This is a full-time position. We offer competitive pay and benefits including medical, dental, vision, and life insurance. You will earn paid time off and paid holidays. We also sponsor a 401k and FSA. We provide paid parking conveniently located near our building.

ClaimDOC is a rapidly growing company in Des Moines striving to change the way healthcare works for the better. You’ll find unrivaled support and a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. ClaimDOC Is a drug- and tobacco-free workplace.

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  • Accepted file types: pdf.