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Form of workJob Description
Acara Solutions is looking for a Medical Claims Auditor for our client located in Remote, TX
- Performs research analytics to support our recovery audit line of business.
- Assists in the development and implementation of new data mining and audit/review methodologies for identifying healthcare overpayments and underpayments to providers, and the detection of healthcare fraud, waste, and abuse.
- Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements.
- Works with data miners, clinical staff, and stakeholders to identify new overpayment issues for each client.
- Tracks, and follows up on results and recoveries.
- Contributes new ideas for improving existing audit processes and audit queries.
- Works cohesively with the audit team.
- Develops, maintains, and ensures adherence to multiple project schedules.
Pay and Benefits:
- The Salary for this position is $22.14 per hour (Max Pay rate).
Required Skills / Qualifications:
- High School Diploma or GED.
- Minimum of 2 years' experience in MS Excel.
- Minimum of 2 years' experience with toggling between screens, organizing/sorting/filtering data.
- Minimum of 2 years' experience in healthcare reimbursement such as provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing or revenue cycle improvement needed.
- Minimum of 2 years' experience with Access line systems or AS400. Understanding of ICD and CPT codes.
- Minimum of 2 years' experience with CMS 1500 Forms for outpatient services and 1450/UBO Forms for inpatient services.
Preferred Skills / Qualifications:
- Bachelor's Degree.
- Medicare and commercial experience.
- Experience in healthcare auditing, reviewing, and validating the accuracy of claims data and accuracy of claims payment.
- Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience.
- Applies knowledge of provider billing and patient accounting practices to the research of client policy and data to reveal new overpayment recovery opportunities.
- Good Conceptual and analytical skills.
- Good Project management skills.
- Ability to develop, organize, and maintain project plans and agendas.
- Ability to effectively interface with clients on the phone and in person.
- Working knowledge of Microsoft Suite of products (Excel, Word, Access).
- Sound understanding of medical terminology and anatomy.
- A good understanding of Medicaid is necessary.
- In-depth knowledge of coding principles including but not limited to NCCI Edits, CPT, HCPCS, and ICD-9 codes and modifiers, or MSDRG, Revenue codes, and APCs.
- In-depth knowledge of UB04 and medical (1500) claim formats and requirements.
- Familiarity with pivoting in Excel.
- Knowledge of healthcare claims processing (Medicaid, Medicare, Commercial Insurance), including ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing.
Additional Information:
- Upon offer of employment, the individual will be subject to a background check and a drug screen.
Aleron companies (Acara Solutions, Aleron Shared Resources, Broadleaf Results, Lume Strategies, TalentRise, Viaduct, and Aleron's strategic partner, SDI) are Equal Employment Opportunity and Affirmative Action Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity, sexual orientation, national origin, genetic information, sex, age, disability, veteran status, or any other legally protected basis. The Aleron companies welcome and encourage applications from diverse candidates, including people with disabilities. Accommodations are available upon request for applicants taking part in all aspects of the selection process.
Applicants for this position must be legally authorized to work in the United States. This position does not meet the employment requirements for individuals with F-1 OPT STEM work authorization status.
