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Medical Claims Auditor Resume Example

Professional Summary

Responsible Claims Auditor proficient in Facets 4.71 andAuditing medical claim forms both 1450 & 1500. Passionate and motivated, with a drive for excellence. [8] years in Auditing field and 2 years in Claims Data Entry Processing field. 

  • Judgment and Decision Making
  • Production and Processing
  • Clerical
  • Time Management
  • Data Entry
  • Researching guidelines/cms/client benefit grids
  • 8 Years Facets 4.71
  • Proclaim
Medical Claims Auditor Jan 2006Present [Company Name] [City], [State] My role as an auditor requires I perform all aspects of pricing on both 1500 & 1450 claims, I'm also familiar  with & perform pricing on Webstrat for 1450 claims. Requirements also include but are not limited to,being up to date on all guideline procedures & use the most accurate information available thru CMS or client based information. I am also familiar with verifying information against most up to date benefit grid information & comp grid information. As an auditor I am required to know & audit all clients that are currently in production which is 12.  I also have experience with both Medicaid & Medicare claims. 
Although it is not a requirement for auditing production is also a necessity & am required to produce up to 45 claims daily & often go above my required 45 audited claims requirement which is not a main goal of an auditor role. 
I am well versed in Facets 4.71 program as this is a daily program I have been using for the past 8 yrs, I have experience with proclaim, cms guidelines & pricing, client based pricing, I complete daily functions of verifying data entry & also have experience in keying data entry as well. My typing speed is roughly around 60-65 wpm. I am able to use when keying both alpha & alpha numeric keypad functions. I review impact statements upon being sent out for changes. I perform & complete all required training from TMG compliance dept. I put myself out there as an employee to my dept to go above & beyond in correcting my faults to become better in my role, I am not opposed to working overtime if necessary when needed. I'm punctual & have been working in a home based position for the past 8 yrs when I first came home. 

Claims Processor Jan 2003Sep 2005 Nationwide Algonac, MI Keyed paper medical claim forms into company based program. Worked edits & system warning message on how to handle claim. Responsible for paying claims according to fee schedule pricing. Also keyed from scratch member reciepts or beneficiary submitted claims & worked accordingly & paid per fee schedule for code billed-responsible for coding procedure codes & Icd-9 dx codes into system from what was submitted. Production based job & 97% QC requirement.
High School Diploma: Buisness Jun 1997 Hazleton Area High School Hazleton, Pa
Medical Office Procedures/billing Feb 2001 Lackawanna Jr. College Hazleton, Pa
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Resume Details

This is a real resume for a Medical Claims Auditor in Nanticoke Pennsylvania, Pennsylvania with experience working for such companies as Company Name, Nationwide. This is one of the hundreds of Medical Claims Auditor resumes available on our site for free. Use these resumes as templates to get help creating the best Medical Claims Auditor resume.

Previous Companies:

  • Company Name
  • Nationwide

Previous Job Positions:

  • Medical Claims Auditor
  • Claims Processor


  • Hazleton Area High School
  • Lackawanna Jr. College

Level of Education:

  • High School Diploma

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