Medical Claim Analyst
Location: Salem Virginia
Description: Medical Recovery Services is looking of Medical Claim Analyst right now, this career will be placed in Virginia. Further informations about this career opportunity please give attention to these descriptions.
Essential Responsibilities:
- Reviews internal reports for audit claims selection.
- Reviews carrier/claim documentation to evaluate adherence to plan parameters and identify billing discrepancies.
- Analyzes the following situations to identify instances of overpayments: (1) payment received by more than one payor, (2) retroactive termination errors, (3) double billing/payments, (4) coordination of benefits overpayments, and (5) coding errors.
- Requests reports as needed to satisfy audit anomalies (high dollar client specific queries, Medicare notes, retir! ee/cobra groups, etc).
- Recommends process improvements! .
- Provides feedback on issues/suggestions regarding filters.
- Tests for new filter development as assigned.
- Posts audit follow-up to include participation in project debrief for continuous improvement.
Basic Qualifications:
- High School Diploma
- Excellent written/oral communication skills.
- Ability to sit and work at a computer for an extended period of time.
- Ability to apply existing knowledge of health care marketplace including commercial and government insurance health plan organizations and HIPAA guidelines with their associated security requirements.
- Ability to analyze and problem solve.
- Ability to multi-task and prioritize.
- Ability to be careful and thorough about detail.
- Ability to organize well.
- Ability to demonstrate a customer service orientation.
- Ability to perform well in team environment, with staff at all levels, to achieve business goals.
- Detailed oriented
- Microsoft Access and Excel experience
- CPT, ICD-9-CM and HCPCS coding knowledge
- Ability to analyze coding and billing situations from looking at claim data
- Minimum of 5 years claims processing experience in a variety of claim types
- Prior auditing experience
- Strong analytical problem solving
- Well-informed, data-driven decision making
- Organizational, detail oriented skills
- Ability to shift priorities
- Ability to maintain confidentiality and a professional business image
Preferred Qualifications:
- Bachelor’s Degree
- Experienced CPC with coding and billing knowledge related to:
o Anesthesia
o Surgery
o Radiology
o Lab
o Therapy
o Modifiers
o NCCI
o And more.
Industry Knowledge
- Understanding of medical terminology, CPT, HCP! CS, and ICD-9 coding ADVANCED
- Understanding of health care insu! rance and claims administration ADVANCED
- Principles and practices of state and federal health administration and quality assurance INTERMEDIATE
- HIPAA Rules and Regulations INTERMEDIATE
- Knowledge of various pricing methodologies INTERMEDIATE
- Knowledge of various cost sharing methodologies INDERMEDIATE
- Proficient in claim adjustments and various types of reprocessing ADVANCED
- .
If you were eligible to this career, please email us your resume, with salary requirements and a resume to Medical Recovery Services.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Tue, 11 Feb 2014 17:59:25 GMT