Healthcare Claims Auditor - Remote Position

About the Role

We are seeking a dedicated Healthcare Claims Auditor to join our team remotely at Karna, LLC. As a Healthcare Claims Auditor, you will play a crucial role in ensuring the accuracy and compliance of healthcare claims, directly impacting public health outcomes. This position offers a unique opportunity to work on significant projects in collaboration with the CDC and NIOSH, enhancing your professional experience while contributing to meaningful health initiatives.

What You'll Do

• Process all claims accurately and promptly according to program guidelines.
• Conduct quality audits on claims adjudicated by claims processors and/or team leads.
• Review and address provider and customer inquiries regarding claim adjudication.
• Handle escalated, high dollar, or complex claims for audit.
• Develop and maintain claims operations policies and procedures.
• Resolve pended healthcare claims and prior approval requests.
• Analyze claims to determine approval or denial for payment.
• Apply knowledge of medical coding and various medical claims forms in the claims process.
• Manage daily workflow for a team of processors, including training new processors.
• Generate reports and analyze data using Microsoft Excel.
• Audit the work of claims processors and serve as a Subject Matter Expert (SME).

Requirements

• High School Diploma required; Associate degree preferred.
• Excellent verbal and written communication skills.
• Minimum of 5 years of claims processing experience.
• Prior experience as a Team Lead or auditor.
• Experience in a high-volume claims operations environment.
• Proficient in Microsoft Office, particularly Excel.

Nice to Have

• Experience with healthcare compliance regulations.
• Familiarity with electronic claims processing systems.
• Knowledge of healthcare reimbursement methodologies.

What We Offer

• Opportunity to work on a major public health project.
• Potential for permanent position after the initial contract.
• Flexible remote work environment.
• Collaborative team culture focused on public health initiatives.
• Professional development opportunities.