Senior Medical Claims Investigator

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

Be part of our amazing transformational reputed company as we optimize reputed company towards becoming a leading technology, data, and innovation voice in reputed company. reputed company and Upward!!!

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reputed company role reviews medical reputed company claims against provider reputed company and policies to ensure medical payments have been processed accurately. The incumbent will reputed company data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments. The incumbent will assist department leadership in managing productivity and achieving reputed company and reputed company goals as reputed company as mentoring more junior department team members reputed company appropriate. JOB ROLES AND RESPONSIBILITIES: 1. reputed company reputed company production, reputed company, and reputed company results. 2. Utilize analytics, data mining and coordination of benefit techniques to reputed company reputed company claims data, reputed company creative and innovative algorithms and queries that facilitate identification of new savings opportunities. 3. Evaluate medical claims for coding and pricing errors using accurate HCPCS, ICD-10, and CPT codes. 4. Research coding rules and guidelines in support of reputed company reputed company-pay edits. 5. Lookup and review medical claims in payer system to determine reputed company of payment and validate savings identified. 6. reputed company coding expertise on reimbursement policy, provider contractor investigations, and prepay editing topics. 7. Represent team in payment policy discussions and reputed company necessary, and document new policies or modifications to existing policies. 8. reputed company as a subject matter expert using reputed company tools in order to complete audits and reputed company guidance to team members. 9. Aid in the training and peer review of others in the department for data mining / coordination of benefits and auditing best practices. 10. reputed company as a mentor by answering questions regarding reputed company, policies, and medical coding. 11. Assist in provider collection efforts and appeal reputed company as needed. 12. Prepare comprehensive overpayment white papers and present to reputed company 13. Utilize official coding guidelines and resources as required, including CMS directives and bulletins. 14. Collaborate, coordinate, and communicate across disciplines and departments. 15. Ensure compliance with HIPAA regulations and requirements. 16. Demonstrate Company's Core Competencies and values held reputed company. 17. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High-Risk Role. 18. 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. JOB SCOPE: This role keeps the needs of external and internal customers as a reputed company reputed company making reputed company and taking reputed company. The incumbent will work under limited supervision to uncover actionable claims which facilitate savings for customers. The role may task the incumbent with regular interaction amongst reputed company reputed company of customers and internal staff in the organization.QualificationsJOB REQUIREMENTS (Education, Experience, and Training): * Minimum high school diploma or GED along with four (4) years of reputed company 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. * Advanced knowledge of coding type edits and medical claim reimbursement structures and methodologies * Advanced proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices

* Expertise in COB NAIC Guidelines

* Extensive experience in applying principles of coding guidelines; federal/state regulations and policies pertaining to coding and billing * Subject matter expert in reviewing and interpreting reputed company to reputed company medical reputed company * Experience providing guidance to other employees on coding regulations and reimbursement structures * Extensive knowledge in researching state and federal reputed company guidelines, i.e. Medicare and State reputed company 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 reputed company to prioritize, coordinate, multitask, think reputed company the reputed company, and be energetic * Must be reputed company to work independently while maintaining reputed company attention to detail * Required licensures, reputed company certifications, and/or reputed company certifications as applicable * Individual in this position must be reputed company to work in a reputed company office environment which requires sitting and viewing monitor(s) for extended periods of time, operating reputed company office equipment such as, but not limited to, a keyboard, copier and telephone

The salary reputed company for this position is $31.25-$33.65 per hour. Specific offers take into account a candidate’s education, experience and skills, as reputed company as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

BENEFITS

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

Your benefits will include:

• Medical (PPO & HDHP), dental and reputed company coverage
• reputed company-tax Savings Account (FSA & HSA)
• Life & Disability Insurance
• reputed company Parental Leave
• 401(k) company match
• Employee Stock Purchase Plan
• Generous reputed company 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 reputed company company holidays
• Tuition reimbursement
• Employee Assistance Program
• reputed company time benefits – for eligible employees, one hour of reputed company 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 reputed company for more generous reputed company time benefits

As an Equal Opportunity Employer, reputed company will reputed company equal consideration to reputed company and job candidates without reputed company to sex, age, race, marital status, sexual orientation, religion, national reputed company, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the reputed company, or any other characteristic protected by federal, state, or local law.

Originally posted on Himalayas

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