Healthcare Claims Systems Auditor (Consultant)

Healthcare Claims Systems Auditor (Consultant)

Remote Position

Client is seeking a highly experienced Healthcare Claims Systems Auditor to lead a short-term, end-to-end audit of our healthcare claims process. This role is ideal for a senior-level expert with deep claims system expertise who can independently trace claims from ingestion through adjudication to payment. The goal is to validate the accuracy, consistency, and integrity of the process and data at each step.

Key Responsibilities:

• Independently execute a comprehensive audit of healthcare claims systems and processes.
• Follow a sample set of claims from initial intake through final payment.
• Validate the logic, data flow, and results at each stage of the claims lifecycle.
• Identify inconsistencies, gaps, or errors in the processing pipeline.
• Provide detailed documentation and recommendations for improvements or remediations.
• Collaborate with internal stakeholders but operate with a high degree of autonomy.

Requirements:

• 8+ years of hands-on experience with healthcare claims systems (payer or provider side).
• Proven experience performing similar audits or forensic reviews of claims systems.
• Deep understanding of claims intake, adjudication, payment, and system integrations.
• Familiarity with EDI formats (e.g., 837, 835) and healthcare data standards.
• Strong analytical, investigative, and documentation skills.
• Ability to work independently with minimal oversight.
• Consulting or project-based experience preferred.

Nice to Have:

• Experience with multiple claims platforms (e.g., Facets, QNXT, HealthEdge, Epic Tapestry, etc.).
• Background in compliance, auditing, or risk management.

Metasys Technologies is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identify, national origin, veteran or disability status.