Claims Audit and Recovery Analysts

Location: United States

Duration: 6 months, contract to hire

Responsibilities:

• 3+ years claims examining all types of claims (professional, facility, ancillary), preferably in Medicare Advantage delegated model
• 2+ years experience in claims overpayment recovery, preferably in Medicare Advantage setting
• Knowledge of claims processing systems (EZCAP preferred)
• Working knowledge of different claims coding requirements, payment methodology (PPS, Medicare fee schedules, etc.), coordination of benefits
• Understanding of Division of Financial Responsibility on how they apply to claims processing
• Intermediate to Advance proficiency in MS Office products – Word, Access and Excel
• Comprehensive knowledge of Medicare Advantage claims processing requirements and other related regulatory requirements
• Knowledge of medical terminology
• Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics
• Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives;
• Demonstrates attention to detail
• Ability to work well in a fast-paced and dynamic environment
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