Expert Claims Quality Specialist
il y a 7 heures
Job Overview:
We are seeking a Claims Quality Specialist to join our team. The ideal candidate will have expertise in medical claims processes and procedures, with the ability to recognize and interpret variances.
- Create clear and accurate audit findings and recommendations that provide feedback to examiners used in examiner scorecards.
- Understand, interpret, and apply coding and reimbursement guidelines to ensure accuracy.
- Audit, assess, and monitor providers and payers, including physicians, inpatient, outpatient, ancillary, behavioral healthcare, laboratory, etc., medical records.
- Analyze inpatient and outpatient medical records using International Classification of Diseases (ICD-9/ICD-10), Current Procedural Terminology (CPT), Health Care Common Procedure Coding System (HCPCS), Universal Billing (UB), and other codes.
- Verify and validate claims documents received through multiple channels to rule out documentation or coding errors.
- Prepare concise documentation and audit reports, including recommendations for improvements with corrective action plans.
- Bachelor's degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field.
- 3-5 years' experience in a customer-focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
- Proficiency in MS Office and general internet navigation and research skills.
- Must be detail-oriented and able to work independently.
We value our employees and strive to create a positive work environment. Our benefits include:
- Hybrid working option available as per business requirements.
- Ongoing training and development opportunities.
- Competitive compensation package.
We prioritize employee well-being and offer resources to support work-life balance and overall health.
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