Claims Audit Extern

About the role

Progyny is seeking a Claims Audit Extern to join our team. This role will primarily support claims audits, quality assurance reviews, and other related audit activities. In this role, you’ll gain hands-on experience in healthcare claims auditing while working with provider clinics and cross-functional teams to support coding accuracy, compliance, and continuous improvement.

Responsibilities

• Participate in claims audits and quality assurance reviews, including selecting and preparing patient claim samples, evaluating claims and provider documentation, validating CPT/HCPCS and ICD-10-CM coding, modifiers, billing accuracy, and adherence to applicable coding and documentation guidelines.
• Document audit findings and prepare audit reports, including workpapers, Executive Summaries/Management Response Forms, and other required audit documentation.
• Provide education to provider clinics and applicable stakeholders regarding audit findings, coding, billing, documentation requirements, and corrective actions.
• Assist with special projects and work cross-functionally with internal departments as needed to support audit initiatives, reporting, data analysis, operational goals, and other assigned responsibilities.

Requirements

• CPC-A, CPC, CCA, CCS, or CCS-P certification required.
• Must be based in the United States; this is not a digital nomad or remote international position.
• Progyny is unable to provide visa sponsorship; candidates must be authorized to work in the United States without the need for sponsorship, now or in the future.
• Occasional travel may be required for in-person audits, team meetings, or other business needs.

Skills

• Strong Microsoft Office skills, particularly Excel, with the ability to work efficiently with large datasets, pivot tables, and structured audit information.
• Working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, coding guidelines, or healthcare claims concepts; familiarity with reimbursement or payer policy research is a plus.
• Excellent written and verbal communication skills with strong attention to detail and the ability to clearly document findings.
• Comfortable working independently in a fast-paced environment while managing multiple priorities and deadlines.
• Demonstrated ability to be adaptive, inquisitive, analytical, and solution-oriented.
• Ability to collaborate effectively with cross-functional stakeholders and communicate professionally with provider clinics and internal leaders.
• Interest in healthcare audit, coding, payment integrity, reimbursement, provider billing, process improvement, or healthcare operations.