ProRec Resource Solutions

Senior Medical Claims Audit & Revenue Integrity Specialist Location: Remote Work Arrangement: 100% Remote Schedule: Flexible based on receipt of claim details Interview: Virtual Contract: Approximately 80 hours, plus potentially 16-24 additional hours of assistance while the claims population is generated and the detailed sample is pulled Role Overview CLA is seeking a Senior Medical Claims Audit & Revenue Integrity Specialist to support a 100% remote medical claims engagement for the State of Arizona. The role requires an advanced billing, coding, or clinical background in medical claims and focuses on reviewing claim accuracy and appropriateness. The work includes ICD-10 coding, procedure and diagnosis codes, claim pricing, contractual requirements, prior authorization and referral requirements, coverage provisions, subrogation, upcoding, and medical necessity. Primary Responsibilities Confirm the accuracy of ICD-10 claim coding...