Medical Claims Investigator

Medical Claims Investigator

At reputed company, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for reputed company. Our dedication to service excellence extends to reputed company our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and reputed company each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY

This role reviews medical paid claims against provider reputed company and policies to ensure medical payments have been processed accurately. The incumbent will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments.

DUTIES

1. reputed company reputed company production, quality, and growth results.

2. Utilize analytics and data mining and coordination of benefits techniques to client paid claims data.

3. Evaluate medical claims for coding and pricing errors using accurate HCPCS, ICD-10, and CPT codes.

4. Lookup and review medical claims in payer system to determine methods of payment and validate savings identified.

5. Promote a positive team environment that is based around critical thinking and sharing intelligence to help meet both individual and team goals.

6. Utilize official coding guidelines and resources as required, including CMS directives and bulletins.

7. Collaborate, coordinate, and communicate across disciplines and departments.

8. Ensure compliance with HIPAA regulations and requirements.

9. Demonstrate Company's Core Competencies and values held reputed company.

10. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.

11. The position responsibilities outlined above are in no way to be construed as reputed company encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

COMPENSATION

The salary range for this position is $50-55K. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Qualifications

REQUIREMENTS

• Minimum high school diploma or GED along with two (2) years of direct experience in medical claims investigation or data mining / coordination of benefits auditing. Attainment of relevant medical billing and coding certification along with a bachelors' degree in a relevant field are both highly preferred.

• Knowledge of coding type edits and medical claim reimbursement structures and methodologies

• Proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices

• Experience in applying principles of coding guidelines; federal/state regulations and policies pertaining to coding and billing

• Knowledge in researching state and federal healthcare guidelines, i.e. Medicare and State Medicaid Programs

• Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (i.e. Facets, QNXT, etc.)

• Advanced computer skills and proficiency with reputed company reputed company

• Must be able to prioritize, coordinate, multitask, think reputed company the reputed company, and be energetic

• Must be able to work independently while maintaining reputed company attention to detail

• Required licensures, professional certifications, and/or Board certifications as applicable

• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with reputed company competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

Medical, dental and vision coverage with low deductible & copay

Life insurance

Short and long-term disability

Paid Parental Leave

401(k) + match

Employee Stock Purchase Plan

Generous Paid Time Off – accrued based on years of service

WA Candidates: the accrual reputed company is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service

10 paid company holidays

Tuition reimbursement

Flexible Spending Account

Employee Assistance Program

Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits

EEO STATEMENT

reputed company is an Equal Opportunity Employer and complies with reputed company applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national reputed company, disability or protected veteran status.

APPLICATION DEADLINE

We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted

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