Remote Internal Claims Auditor

Company Description

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.  

Join us as we put healthcare on a better path!!  

Job Description

WHAT YOU’LL BE DOING

• Understand and stay current with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations. 
• Ensure accuracy of claims processing and contract logic builds through internal audit processes.
• Perform targeted audits of claims processing including, but not limited to, high dollar payments, benefit matrix, interest payments, pre-payment and post-payment audits, and multiple procedure claims.
• Perform quality audits of claims staff, eligibility staff, and system logic.
• Perform audits of new client setup in the claims processing software.
• Run access queries as needed for administrative purposes. 
• Other duties and responsibilities as assigned. 

Qualifications

WHAT YOU'LL NEED TO HAVE

• Minimum 3 years of experience in the healthcare or managed care industry, including claims/reimbursement experience, professional analytics-related experience and experience working on/managing major projects
• 1-3 years auditing experience in the healthcare industry
• Advanced to expert proficiency in the Microsoft Office products, especially Microsoft Word, Microsoft Excel & Microsoft Access
• Able to problem solve, exercise initiative, and make low to medium level decisions
• Thorough understanding of current federal, state and local healthcare compliance requirements
• Ability to meet deadlines and prioritize tasks; collect, correlate, and analyze data
• Ability to work independently with minimal supervision and as part of a team
• Must be organized, self-motivated, detail-oriented, disciplined, professional, and a team player
• Effective written and oral communication

WOULD LOVE FOR YOU HAVE

• Bachelor’s degree in healthcare informatics, business administration, or related field, or equivalent in experience and education 
• Certified Professional Coder strongly recommended
• Prior claims processing experience within Eldorado HealthPac Claims Adjudication System is a plus
• Claim coding experience, coding edits experience and APC Pricing knowledge
• CPT and ICD coding knowledge 

Additional Information

The base pay range for this role is between $21-$24  per hour, paid bi-weekly

All your information will be kept confidential according to EEO guidelines.

BENEFITS:

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with u