High Cost Drug Auditor III

Responsibilities: Perform extensive audit reviews of high cost drug (HCD) claims using HCPCS codes and medical record reviews. Document audit findings with professional communications and identify industry trends and opportunities.

Requirements: Requires at least three years of experience in claims processing or HCD medical billing with expert knowledge of HCPCS codes. A high school diploma is required, while certifications like CPhT, RHIA, or CPC are preferred.

Key skills: HCD Claims Billing, HCPCS Codes, Medical Record Review, Audit Review, Contract Interpretation, Fee Schedules, Microsoft Word, Microsoft Excel, Basic Math, Analytical Skills, Written Communication, Verbal Communication, Time Management, Problem Solving, Medical Terminology, Claims Processing

Keywords: HCD, HCPCS, Medical Billing, Claims Processing, FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat, Pricers, CPhT, RHIA, CPC, Medical Terminology, Audit, Healthcare Payer, Data Analytics