Engagement Description –
• Reviewing claim submissions and verifying claims processed correctly.
• Auditing claims-making sure the system applied the correct benefits, pricing, and cost share values.
o Comparing claims data to the members benefits and other policy documents.
o Ensuring the system applied to correct allowed amounts using CMS fee schedules.
o Confirmed system applied the correct member cost share amounts based on benefit documents.
• Performing other clerical tasks, as required.
Top 3 Required Skills/Experience –
• 5 years medical claims experience (HCFA and UBs)
• In depth knowledge of medical claim coding
• Proficient in Microsoft Word and Excel
Required Skills/Experience – The rest of the required skills/experience. Include:
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Ability to work under pressure, perform a range of clerical functions with great attention to detail.
Preferred Skills/Experience – Optional but preferred skills/experience. Include:
• Medicare claims and compliance experience
• Comfortable working independently
• Understands the importance of deadlines
Function Information Technology
Req ID JN -082023-120355