Medical Claims Auditor
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Our client is currently seeking a Medical Claims AuditorIrving, TX
We are seeking a talented individual for a Medical Claims Auditor I who 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.
This job will have the following responsibilities:
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.
Applies knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new overpayment recovery opportunities.
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
Knowledge , Skills and Abilities
Strong Conceptual and analytical skills
Strong 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 or medical terminology and anatomy.
Good understanding of Medicaid required, Medicare and commercial experience a plus.
In depth knowledge of coding principals including but not limited to NCCI Edits, CPT, HCPCS and ICD-9 codes and modifiers; and/or MSDRG, Revenue codes, and APCs.
In depth knowledge of UB04 and medical (1500) claim formats and requirements.
Qualifications & Requirements:
Minimum Education:High school diploma or GED required; Bachelor's degree preferred
Minimum Related Work Experience:1-3 years of healthcare reimbursement experience such as provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing, and/or revenue cycle improvement required.
Must have demonstrated experience and knowledge of healthcare claims processing (Medicaid, Medicare, Commercial Insurance), including ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, etc.
Preferred Experience in healthcare auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred.
Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience a plus preferred
IF INTERESTED AND QUALIFIED, TAKE ACTION NOW AND APPLY!!!!
Please send your MOST UP TO DATE resume to James at ~~~ or give James a ****
, National Healthcare Recruiter , The Judge Group 12700 Park Central Drive, Suite 1070, Dallas, TX 75251
Phone ~~~ - ~~~
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CLINICAL WORKFORCE SOLUTIONS
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Working at the crossroads of people and transformative technologies, The Judge Group delivers innovative business solutions – powered by top talent – to help organizations reach their strategic goals and realize opportunities now and in the future.
The Judge Group is a leading professional services firm specializing in technology, talent, and learning solutions. Our services are successfully delivered through a network of more than 35 offices in the United States, Canada, China, and India. The Judge Group serves more than 40 Fortune 100 companies and is responsible for the placement of more than 4,500 professionals annually across a wide range of industries. To learn more, visit ~~~.
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