Claims Audit Coordinator, Billing

About Cedar Gate Technologies

Cedar Gate Technologies, an IQVIA business, enables payers, providers, employers, and service administrators to excel at value-based care with a unified technology and services platform delivering analytics, care, and payment technology on a single data management foundation. At Cedar Gate, you’ll be part of a collaborative, innovative environment where great ideas thrive. We invest deeply in our people through ongoing training, comprehensive benefits, and a strong culture of teamwork, offering the chance to grow your skills while contributing to high impact initiatives for some of the world's most dynamic companies.

Position Summary

Billing Coordinator is responsible for the timely and accurate preparation, review, and submission of medical claims to third-party payers. This position supports value-based care billing activities by ensuring claims are processed in accordance with established procedures, payer requirements, and contractual guidelines. The role requires maintaining accurate records, researching claim issues, and supporting daily billing operations.

Roles & Responsibilities

• Prepare, review, and submit paper and electronic claims for processing and reimbursement.
• Distribute claims to appropriate payers in accordance with established billing procedures.
• Review claims for completeness and accuracy and correct invalid or incomplete claims as needed.
• Maintain knowledge of billing and packaging protocols related to assigned service lines and reimbursement programs.
• Research and document patient encounter information necessary for claim processing and reimbursement.
• Monitor and report claim filing activity and billing exceptions according to department guidelines.
• Identify, investigate, and resolve claim-related issues in coordination with internal and external stakeholders.
• Maintain accurate physician, payer, and contract information within applicable systems.
• Utilize designated billing and information systems to obtain patient, insurance, and claim information.
• Support billing operations through data entry, claim auditing, claim filing, record maintenance, and cross-training activities.
• Enter claim information into applicable systems and reconcile charges to ensure accuracy and completeness.
• Review and route claims with missing or invalid information for research and resolution.
• Maintain filing systems and records related to claims, provider transmittals, EOBs, medical records, and other supporting documentation.
• Ensure compliance with HIPAA and company confidentiality requirements.
• Participate in departmental meetings and required training activities.
• Complete additional duties as assigned.

Job Location

Houston, TX (Galleria Area)

Work Arrangement

Hybrid (3 days in office, 2 remote)    

Experience / Qualifications

• Minimum of five years of medical billing experience.
• Knowledge of medical billing processes, insurance terminology, and reimbursement practices.
• Experience working with Medicare, Medicaid, commercial insurance carriers, and managed care plans.
• Working knowledge of ICD-10, CPT, and HCPCS coding systems.
• Experience with billing software, electronic health records, and related healthcare systems.
• Proficiency with Microsoft Word, Excel, Outlook, and other standard business applications.
• Strong organizational skills and attention to detail.
• Ability to prioritize tasks, manage workload, and meet established deadlines.
• Ability to work independently and within a team environment.
• Experience with alphanumeric data entry and maintaining accurate records.
• High school diploma or equivalent; Associate's or Bachelor's degree preferred
• Strong preference for those who have experience with value-based care reimbursement models or bundled payment programs.
• Experience supporting cardiology, radiology, anesthesiology, or other specialty physician practices.
• To be eligible for this position, you must reside in the same country where the job is located.

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com

IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. https://jobs.iqvia.com/eoe

IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.

The potential base pay range for this role, when annualized, is $37,400.00 - $93,600.00. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.