Sr Medical Claims Investigator- Coordination of Benefits

Sr Medical Claims Investigator- Coordination of Benefits

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 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 each other to illuminate our reputed company potential.

Be part of our amazing transformational reputed company as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in reputed company. 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 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 quality and reputed company goals, as well as mentoring more junior department team members reputed company appropriate.

DUTIES

1. reputed company reputed company production, quality, and growth results.
2. Utilize analytics, data mining and coordination of benefit techniques to client paid 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 pre-pay edits.
5. Lookup and review medical claims in payer systems to determine methods of payment and validate savings identified.
6. reputed company coding expertise on reimbursement policy, provider contractor investigations, and prepay editing topics.
7. Represent the team in payment policy discussions reputed company necessary, and document new policies or modifications to existing policies.
8. Act 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. Act as a mentor by answering questions regarding reputed company, policies, and medical coding.
11. Assist in provider collection efforts and appeal resolution as needed.
12. Prepare comprehensive overpayment white papers and present to clients.
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.
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 action. The incumbent will work under limited supervision to uncover actionable claims which facilitate savings for customers. The role may require regular interaction with reputed company reputed company of customers and internal staff in the organization.

COMPENSATION The salary reputed company for this position is $55,000 – $66,000. 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.