Data Quality Auditor (Contract)

Job Description: Ensure the accurate and correct processing of medical claims based on contractual obligations and regulatory requirements Conduct pre-payment, post-payment, and auto-adjudication audits for claims Ensure processing, payment, and financial accuracy of claims Meticulously track and report audit results Identify corrections and confirm accuracy of adjustments Escalate trends and issues for process improvement Investigate claim issues to improve standard processing guidelines Participate in cross-functional quality committees Support testing efforts for claims system upgrades Participate in client external audits Process claims and create policies as necessary Requirements Bachelor's Degree or equivalent work experience 2 years of experience auditing medical claims for a health insurer or TPA Extensive (5 years) medical claims processing background Ability to analyze data and recognize trends; use of the 5 Whys to determine the true root cause of an issue Core system configuration knowledge Ability to articulate findings and defend methodology used to produce findings Strong independent decision-making, influencing, and analytical skills Excellent communication skills Demonstrated success getting results through collaboration Previous startup company experience (extra credit) Previous Payment Integrity experience (extra credit) Coding certification from AAPC or AHIMA (extra credit) Familiarity with Javelina claims processing software (extra credit) Benefits Alternative medicine coverage Generous PTO Up to 16 weeks paid parental leave Paid holidays 401k program Transportation perks Education reimbursement Paid paw-ternity leave