- Our culture appreciates and rewards creative ideas, especially those that achieve better outcomes for everyone
- Remote hybrid work schedule with flexible hours in Houston, Texas.
- This is viewed as a key position for our continued success, and it will have a direct impact on client satisfaction.
- We are a rapidly growing company with limitless career growth and advancement for top performers
As the Claims Audit and Recovery Specialist, you will audit claims for both inbound and outbound claims activity. In addition, the Claims Audit and Recovery Specialist will recover overpaid claims, manage recovery activity, and manage leakage activity. You will be communicating regularly with Cedar Gate leadership and clients.
Roles & Responsibilities
- Conduct claim audits of external inbound claims activity for various clients to ensure that the claims processed have all appropriate charges required for packing.
- Conduct claim audits of claims processed by NDBH staff to assure adherence to processing policies and guidelines.
- Ensure accuracy standards are met.
- Prepare reports on audit results, identify trends, and implement quality improvement activities for improving business processes.
- Pursue and manage recovery of inappropriate overpayments and apply recoveries to the claims payment system.
- Track and report leakage details, including the review and audit of incoming leakage reports
- Assist in the preparation of settlement and Recovery reports.
- Follows interdepartmental policies and procedures as set by supervisor/manager.
- Provide coverage for all essential functions of billing activities (data entry, claim filing, claim storage, claim auditing, and cross-training on package protocols per assignment).
- Maintain confidentiality of all information in accordance with HIPAA and with company information.
- Attend all regular staff meetings.
- Participate in continuing educational programs to maintain current on area of specialty.
- Work overtime, as required.
- Performs other tasks as assigned by supervisor/manager.
Job Location:
Required Experience / Qualifications
- Certificate or associate degree in claims billings; Certified Coding Associate or Certified Professional Coder preferred
- Three (3) or more years of claims processing experience.
- Two (2) years of audit or recovery experience, preferably with medical claims.
- Ability to communicate with others clearly, tactfully, and professionally.
- Must be detail-oriented and proficient in data entry skills
- Advanced reporting in Microsoft Excel
- Currently eligible to work in the USA without a work visa, except for those with TN visas
Your Future Working Environment
About Cedar Gate
Based in Greenwich, CT, Cedar Gate is private equity backed by GTCR, a leading Chicago-based private equity firm, Ascension Ventures, a strategic healthcare venture firm, and Cobalt Ventures, the investment subsidiary of BCBS of Kansas City. To learn more, visit www.cedargate.com.