Base: $74,612 - $98,488 usd; bonus: included in to...
Remote
5+ years medicare/medicaid claims experience
Proficiency in cpt/hcpcs and icd-10 coding
Knowledge of cms and medi-cal regulations
WelbeHealth is seeking a Claims Audit Specialist to ensure the accurate processing and compliance of Medicare and Medi-Cal claims while adhering to federal and state regulations. The role requires extensive experience in health plan operations and offers a competitive benefits package, including medical insurance and generous paid time off
Job Summary
The role ensures accuracy and compliance by auditing complex Medicare and Medi-Cal claims, directly impacting financial integrity and regulatory adherence.
Candidates will review processed claims for pre and post payment accuracy while maintaining acceptable levels of aged claims inventory.
WelbeHealth offers a comprehensive compensation package including medical insurance, 401K match, and 17 days of personal time off.
Matching Summary
Match Score: 85
WelbeHealth is seeking a Claims Audit Specialist to ensure the accurate processing and compliance of Medicare and Medi-Cal claims while adhering to federal and state regulations. The role requires extensive experience in health plan operations and offers a competitive benefits package, including medical insurance and generous paid time off.
Salary
Base: $74,612 - $98,488 USD; Bonus: Included in total rewards; Benefits: Medical, Dental, Vision, 401(k) match
Skills & Requirements
Must-have
5+ years Medicare/Medicaid claims experience
Proficiency in CPT/HCPCS and ICD-10 coding
Knowledge of CMS and Medi-Cal regulations
Experience with professional and institutional claims
Advanced Microsoft Excel skills
Nice-to-have
Strong analytical and communication skills
Passion for accuracy and continuous improvement
Ability to identify trends and mitigate risk
Experience with dispute resolution and appeals
Key Requirements
Bachelor's degree or equivalent experience
Minimum five years of claims processing experience
Working knowledge of federal and state healthcare regulations