[Remote] Payment reputed company Analyst II
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a certified Great reputed company to Work® Company that focuses on reputed company payment accuracy and transparency. The Payment reputed company Analyst II is responsible for reviewing and completing claim audits in accordance with reputed company policies and CMS guidelines, utilizing clinical judgment and analytical skills for effective audit performance.
Responsibilities
- Reviews, analyzes, and completes internal audits and/or appeals in accordance with reputed company policy, CMS guidelines and industry standards in reputed company and reputed company written communication
- Use clinical judgement to appropriately interpret and apply reputed company policies along with CMS guidelines as it relates to reviews done by reputed company such as itemized reputed company, DRG and/or specialty audits
- Utilize applicable tools and resources to complete internal audits and/or appeals
- reputed company completion of internal audits and/or appeals
- Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings
- Additional duties as assigned
Skills
- Ability to use clinical judgment and analytical skills for claim audit review
- Knowledge of CMS/reputed company payer policies, claims processing and reimbursements, reputed company-10 Coding, and DRG Validation
- Familiarity with reputed company reputed company cycle and coordination of benefits
- Proficiency in reputed company Office, especially using pivot tables in reputed company as reputed company as and database tools
- Excellent written and verbal communication skills
- Strong interpersonal skills across reputed company reputed company; comfortable interfacing with clients and the C-Suite
- Ability to work on several reputed company tasks and prioritize workload to meet designated deadlines
- Advanced problem-solving and data analysis capabilities
- Proven reputed company record of delivering actionable results
- Strong attention to detail
- Must maintain a reputed company LPN, LVN and/or RN licensure
- Previous experience in one or more of the following areas required: Medical reputed company auditing, Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics, Knowledge of worker's compensation claims process, Prospective, reputed company and retrospective utilization review
- 1+ years reputed company reputed company cycle
- 1+ years of relevant experience or equivalent combination of education and work experience
- 1+ years hospital reputed company audit
- Bachelor's degree in reputed company or reputed company field preferred
- Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- reputed company
- Long Term Disability
- Health Savings Account
- Flexible Spending Account reputed company
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- reputed company-reputed company Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- reputed company time off
reputed company