Quality Auditor - Radiology and Cardiology Medical Claims

Job Summary Progressive Technology is seeking a highly skilled and detail-oriented Quality Auditor to join our team. The successful candidate will be responsible for reviewing and auditing medical claims related to radiology and cardiology services. This role is crucial in ensuring that claims are processed accurately and in compliance with all relevant regulations and industry standards. The Quality Auditor will work closely with other teams to maintain high-quality standards and resolve any discrepancies in claims. This is an excellent opportunity for an experienced professional looking to grow their career in the healthcare industry. Key Responsibilities • * Perform thorough audits on radiology and cardiology medical claims, ensuring that they meet industry standards and comply with both internal and external regulations. • * Identify, investigate, and resolve discrepancies in medical claims, ensuring timely resolution and documentation. • * Ensure accuracy and completeness in claims processing, verifying that all necessary documentation is included and accurate. • * Collaborate with claims processors, billing departments, and medical professionals to clarify any issues with claims. • * Maintain up-to-date knowledge of medical coding, insurance regulations, and healthcare policies to ensure compliance. • * Provide feedback and recommendations for process improvements to ensure more efficient claims processing. • * Prepare detailed audit reports summarizing findings, discrepancies, and corrective actions taken. • * Ensure that all audits are completed in a timely manner, in accordance with departmental guidelines. • * Assist in training and mentoring new auditors and other team members as needed. • Required Skills and Qualifications • * Bachelors degree in Healthcare Administration, Health Information Management, or a related field (or equivalent experience). • * Strong knowledge of medical coding systems (ICD-10, CPT, HCPCS). • * In-depth understanding of radiology and cardiology medical claims and procedures. • * Familiarity with healthcare insurance, payer policies, and reimbursement processes. • * Proficiency in auditing and claims processing software. • * Excellent analytical skills and attention to detail. • * Strong communication skills, both written and verbal, with the ability to explain complex information to non-experts. • * Ability to work independently, manage time effectively, and meet deadlines. • * Ability to collaborate and work well with cross-functional teams. • Experience • * Minimum of 3 years of experience in medical claims auditing, preferably with a focus on radiology and cardiology. • * Experience working with healthcare providers, insurance companies, and medical coding professionals. • * Proven track record of identifying and resolving discrepancies in medical claims. • * Experience with regulatory compliance and knowledge of federal and state healthcare regulations. • Working Hours • * Full-time position • * Standard working hours: Monday to Friday, 9:00 AM - 5:00 PM • * Occasional overtime may be required during peak periods. • Knowledge, Skills, and Abilities • * Strong understanding of medical terminology, particularly in the areas of radiology and cardiology. • * Expertise in medical claims processing, auditing, and regulatory compliance. • * Ability to handle sensitive information with discretion and maintain confidentiality. • * Proficiency in using auditing tools, databases, and claims processing software. • * Ability to think critically and solve complex problems efficiently. • * Strong organizational skills and attention to detail. • * Knowledge of healthcare reimbursement models and payer-provider interactions. • Benefits • * Competitive salary and performance-based incentives. • * Comprehensive health benefits package (medical, dental, vision). • * Retirement savings plan with company match. • * Paid time off (PTO) and holiday pay. • * Professional development opportunities and training programs. • * Flexible work arrangements, including remote work options. • * Employee wellness programs and support for work-life balance. • * Access to industry events and conferences. • Why Join Progressive Technology? At Progressive Technology, we value the contributions of our employees and strive to create a supportive, innovative, and inclusive work environment. As a leader in the healthcare technology sector, we are committed to driving excellence in everything we do. By joining our team, you will be part of a dynamic company that provides opportunities for growth, development, and career advancement. We offer competitive salaries, a comprehensive benefits package, and a culture that values your expertise. How to Apply If you are passionate about healthcare quality and have the skills and experience to succeed in this role, we encourage you to apply! Please submit your resume and cover letter via our career portal on the Progressive Technology website. In your cover letter, be sure to highlight your experience with radiology and cardiology medical claims, as well as any relevant certifications. Our hiring team will review your application and contact you if your qualifications match our needs. 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