Medical Necessity Examiner and Quality Auditor

Medical Necessity Examiner and Quality Auditor

General Job Vacancy: Medical Necessity Examiner and Quality Auditor  

If you're a self-motivated, detail-oriented professional with a passion for meeting deadlines, we welcome you to join our team. Whether you're seeking a full-time role or prefer remote work, if you're eager to collaborate with a group of highly driven experts in administration, medical or insurance, we encourage you to apply.

General Responsibilities:

Play a pivotal role in our comprehensive claims review and payment process. Your responsibilities will include examining health insurance claims, ensuring accuracy, verifying the appropriate application of benefits, authorizing services, and interpreting insurance policies.

• Apply clinical knowledge to examine medical insurance claims.
• Work with patients and healthcare providers to seek correct documentation.
• Meet assigned deadlines and targets and work under minimal supervision.
• Assist in determining medical necessity, usual, customary and reasonable rates.
• Process pre-certification and pre-authorizations
• Determine appropriate CPT, ICD-10 and other codes.

Education, Skills and Qualifications:

-          Self-motivated, detail-oriented and deadline-driven

-          Bachelor’s Degree in a health-related field

-          3+ years’ work experience in a health-related field

-          Experience with MS Word and Excel

-          Knowledge of medical terminology

-          Excellent interpersonal skills

Why Virsag?

Join VIRSAG and be a part of our exciting journey as we continue to grow and make waves in the industry. We look forward to you being a part of our success story. With a focus on technological innovation and employee development, we're committed to expanding our footprint while maintaining our values of operational efficiency and excellence in medical claims processing.

We appreciate your interest and invite all qualified candidates to apply. Do note, only shortlisted candidates will be contacted.

Thank you.