Audit Technician Denied Medical Claims

Key Responsibilities

• Review denied medical claims to determine reasons for denial (coding errors, missing information, medical necessity, eligibility, etc.).
• Collect, organize, and verify supporting documentation needed for appeals or audit.
• Prepare and submit claim audit packets for internal review or external payor reconsideration.
• Collaborate with clinical staff, coders, and billing teams to resolve discrepancies and correct claim data.
• Maintain accurate tracking of denied claims, appeals filed, and outcomes for reporting purposes.
• Identify trends in denials and escalate recurring issues to management for process improvement.
• Ensure compliance with HIPAA, CMS, and payor guidelines.
• Assist with internal audits, quality checks, and special projects as assigned.

Qualifications

• Bachelor's degree in healthcare administration, business, or related field preferred.